title: Meta-analysis of short- and mid-term efficacy of ketamine in unipolar and bipolar depression.
abstract: Among treatments currently assessed in major depression, ketamine, has been proposed of great interest, especially because of its very rapid action. However, the time-course of the antidepressive action of ketamine remained unclear. In the present meta-analysis, we provided a clear and objective view regarding the putative antidepressive effect of ketamine and its time-course. We searched the MEDLINE and PsycINFO databases through December 2013, without limits on year of publication, using the key words ketamine and synonyms for mood disorder or episode. Six randomized, double-blind and placebo-controlled trials of ketamine in major depression (n=103 patients) were thus identified. Authors were contacted and they all provided original data necessary for this meta-analysis. Standardized mean differences (SMD) were calculated between the depression scores in ketamine and placebo groups at days 1, 2, 3-4, 7 and 14. Ketamine showed an overall antidepressive efficacy from day 1 to day 7. However, the maintenance of its efficacy over time failed to reach significance in bipolar depression after day 3-4. Significant SMDs were not explained by demographic or clinical characteristics of included samples. The present meta-analysis provides a high level of evidence that ketamine has a rapid antidepressive action during one week, especially in unipolar disorder.
authors.affiliation: AP-HP, Pitié-Salpêtrière Hospital, Department of Psychiatry, F-75013 Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Romeo
authors.affiliation: AP-HP, Pitié-Salpêtrière Hospital, Department of Psychiatry, F-75013 Paris, France.
authors.forename: Walid
authors.initials: W
authors.lastname: Choucha
authors.affiliation: AP-HP, Pitié-Salpêtrière Hospital, Department of Psychiatry, F-75013 Paris, France; Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, Institut du Cerveau et de la Moelle, ICM, Social and Affective Neuroscience (SAN) Laboratory, F-75013 Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Fossati
authors.affiliation: AP-HP, Pitié-Salpêtrière Hospital, Department of Psychiatry, F-75013 Paris, France; Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, Institut du Cerveau et de la Moelle, ICM, Social and Affective Neuroscience (SAN) Laboratory, F-75013 Paris, France. Electronic address: jeanyves.rotge@mac.com.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Rotge
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D002986:Clinical Trials as Topic / Q000379:methods; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004311:Double-Blind Method; D006801:Humans; D007649:Ketamine / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D007649:Ketamine
keywords: Depression; Glutamate; Ketamine; Meta-analysis; Mood disorder; Unipolar disorder