Abstract：
Mood disorders, anxiety, and suicidality in youth are increasing and rapid-acting treatments are urgently needed. One potential is ketamine or its enantiomer esketamine, which was FDA approved in 2019 to treat major depressive disorder with suicidality in adults. This systematic review evaluated the evidence for the clinical use of ketamine to treat mood disorders, anxiety, and suicidality in youth. The PRISMA guidelines were used, and a protocol registered prospectively ( https://osf.io/9ucsg/ ). The literature search included Pubmed/MEDLINE, Ovid/MEDLINE, Scopus, CINAHL, PsychInfo, and Google Scholar. Trial registries and preprint servers were searched, and authors contacted for clarification. Studies reported on the clinical use of ketamine to treat anxiety, depression, bipolar disorder, or suicidality in youth ≤19 years old and assessed symptoms before and after ketamine use. Study screening and data extraction were conducted independently by 2-4 authors. Safety, tolerability, and efficacy data were collected. The Cochrane Risk of Bias guidelines assessed the quality of the evidence. Twenty-two published reports based on 16 studies were identified: 7 case studies, 6 observational studies, 3 randomized trials, and 6 secondary data analyses. Studies reported immediate improvements in depression, anxiety, and suicidality. Improvements were maintained for weeks-months following treatment. Ketamine was well-tolerated with the most common side effects being dizziness, nausea, and mild dissociation. Transient hemodynamic changes were reported, all of which resolved quickly and did not require medical intervention. Initial evidence suggests ketamine is safe and may be effective for mood disorders, anxiety, and suicidality in youth. Further randomized trials are warranted.
摘要：
情绪失调,焦虑,年轻人的自杀率正在增加，迫切需要速效治疗。一种潜力是氯胺酮或其对映体艾氯胺酮，FDA于2019年批准用于治疗成人重度抑郁症伴自杀。这项系统评价评估了临床使用氯胺酮治疗情绪障碍的证据。焦虑,和年轻时的自杀。使用了PRISMA指南，和预期注册的协议（https://osf.io/9ucsg/）。文献检索包括Pubmed/MEDLINE，Ovid/MEDLINE,Scopus,CINAHL,PsychInfo,谷歌学者。搜索了试验登记处和预印服务器，和作者联系澄清。研究报道了氯胺酮治疗焦虑症的临床应用，抑郁症,双相情感障碍,青年≤19岁或自杀，并在使用氯胺酮前后评估症状。研究筛选和数据提取由2-4名作者独立进行。安全,耐受性,并收集疗效数据。Cochrane偏差风险指南评估了证据的质量。根据16项研究确定了22份已发表的报告：7份案例研究，6观察性研究，3项随机试验，和6次二次数据分析。研究报告说，抑郁症立即得到改善，焦虑,和自杀。改善在治疗后维持数周至数月。氯胺酮耐受性良好，最常见的副作用是头晕，恶心,和温和的分离。报告了短暂的血液动力学变化，所有这些都迅速解决，不需要医疗干预。初步证据表明氯胺酮是安全的，可能对情绪障碍有效，焦虑,和年轻时的自杀。需要进一步的随机试验。
