title: Administration of ketamine for unipolar and bipolar depression.
abstract: OBJECTIVE
  Clinical trials demonstrated that ketamine exhibits rapid antidepressant efficacy when administered in subanaesthetic dosages. We reviewed currently available literature investigating efficacy, response rates and safety profile.
  
  
  METHODS
  Twelve studies investigating unipolar, seven on bipolar depression were included after search in medline, scopus and web of science.
  
  
  RESULTS
  Randomized, placebo-controlled or open-label trials reported antidepressant response rates after 24 h on primary outcome measures at 61%. The average reduction of Hamilton Depression Rating Scale (HAM-D) was 10.9 points, Beck Depression Inventory (BDI) 15.7 points and Montgomery-Asberg Depression Rating Scale (MADRS) 20.8 points. Ketamine was always superior to placebo. Most common side effects were dizziness, blurred vision, restlessness, nausea/vomiting and headache, which were all reversible. Relapse rates ranged between 60% and 92%. To provide best practice-based information to patients, a consent-form for application and modification in local language is included.
  
  
  CONCLUSIONS
  Ketamine constitutes a novel, rapid and efficacious treatment option for patients suffering from treatment resistant depression and exhibits rapid and significant anti-suicidal effects. New administration routes might serve as alternative to intravenous regimes for potential usage in outpatient settings. However, long-term side effects are not known and short duration of antidepressant response need ways to prolong ketamine's efficacy.
authors.affiliation: a Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Kraus
authors.affiliation: b Department of Adult Psychiatry , Poznan University of Medical Sciences , Poznan , Poland.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Rabl
authors.affiliation: a Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Vanicek
authors.affiliation: a Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria.
authors.forename: Laura
authors.initials: L
authors.lastname: Carlberg
authors.affiliation: a Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria.
authors.forename: Ana
authors.initials: A
authors.lastname: Popovic
authors.affiliation: a Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria.
authors.forename: Marie
authors.initials: M
authors.lastname: Spies
authors.affiliation: a Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria.
authors.forename: Lucie
authors.initials: L
authors.lastname: Bartova
authors.affiliation: a Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria.
authors.forename: Gregor
authors.initials: G
authors.lastname: Gryglewski
authors.affiliation: a Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Papageorgiou
authors.affiliation: a Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria.
authors.forename: Rupert
authors.initials: R
authors.lastname: Lanzenberger
authors.affiliation: a Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria.
authors.forename: Matthäus
authors.initials: M
authors.lastname: Willeit
authors.affiliation: a Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Winkler
authors.affiliation: b Department of Adult Psychiatry , Poznan University of Medical Sciences , Poznan , Poland.
authors.forename: Janusz K
authors.initials: JK
authors.lastname: Rybakowski
authors.affiliation: a Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Kasper
mesh_terms: D001714:Bipolar Disorder / Q000188:drug therapy*; D003866:Depressive Disorder / Q000188:drug therapy*; D018691:Excitatory Amino Acid Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*
chemical_list: D018691:Excitatory Amino Acid Antagonists; D007649:Ketamine
keywords: Ketamine; NMDA-receptor; depression; glutamate; rapid antidepressant