A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders

@article{Sanacora2017ACS,
  title={A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders},
  author={Gerard Sanacora and Mark A. Frye and William M. McDonald and Sanjay J. Mathew and Mason S. Turner and Alan F. Schatzberg and Paul Summergrad and Charles B. Nemeroff},
  journal={JAMA Psychiatry},
  year={2017},
  volume={74},
  pages={399–405}
}
Importance Several studies now provide evidence of ketamine hydrochloride’s ability to produce rapid and robust antidepressant effects in patients with mood and anxiety disorders that were previously resistant to treatment. Despite the relatively small sample sizes, lack of longer-term data on efficacy, and limited data on safety provided by these studies, they have led to increased use of ketamine as an off-label treatment for mood and other psychiatric disorders. Observations This review and… 
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Considerations on the Off-label Use of Ketamine as a Treatment for Mood Disorders
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A Viewpoint summarizes a number of important issues related to the clinical use of ketamine for the treatment of psychiatric disorders addressed in the consensus statement and provides suggestions for addressing remaining concerns.
Use of Ketamine in Clinical Practice: A Time for Optimism and Caution.
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A thoughtful overview of ketamine use, including commentary about patient selection, risks, clinician experience, treatment setting, drug administration, and follow-up, and major limitations in the available data are acknowledged.
Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation.
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An international group of mood disorder experts provides a synthesis of the literature with respect to the efficacy, safety, and tolerability of ketamine and esketamine in adults with treatment-resistant depression and provides guidance for the implementation of these agents in clinical practice.
Ketamine for Depression, 2: Diagnostic and Contextual Indications.
  • C. Andrade
  • Psychology
    The Journal of clinical psychiatry
  • 2017
TLDR
Diagnostic indications for the off-label use of ketamine as an antidepressant and possible contexts in which ketamine may be trialled are examined.
Updates on Preclinical and Translational Neuroscience of Mood Disorders: A Brief Historical Focus on Ketamine for the Clinician.
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A systematic search of PubMed/MEDLINE indexed reports was performed to identify clinical and translational research done with ketamine for purposes of treating depression and the rationale for investigating ketamine and other N-methyl-D-aspartate receptor antagonists as a novel class of glutamate system targeting antidepressants is presented.
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TLDR
Emerging evidence suggests a strong role for the glutamatergic system in the pathophysiology of mood disorders, which may provide more efficient therapeutic targets in the development of novel antidepressants.
Ketamine: A Review for Clinicians.
TLDR
The history of ketamine's development as a potential antidepressant, current hypotheses related to its mechanisms of action, and existing evidence for its safety and efficacy are reviewed with a focus on clinicians' interests.
Ketamine treatment for depression: a review
This manuscript reviews the clinical evidence regarding single-dose intravenous (IV) administration of the novel glutamatergic modulator racemic (R,S)-ketamine (hereafter referred to as ketamine) as…
Ketamine: New Use for an Old Hat
TLDR
Current data points to a rapid and robust action of ketamine as an antidepressant, even in treatmentresistant patients, and available data are insufficient to recommend its routine use in clinical practice in psychiatry or its inclusion in guidelines for management of depression.
Ketamine for the Treatment of Depression.
TLDR
There is now convincing evidence that ketamine has properties to provide prompt antidepressant effects, especially in patients with resistant mood and anxiety disorders, and ketamine will be included in daily practice, but there are a few further complications to be taken into consideration by any practitioner.
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References

SHOWING 1-10 OF 46 REFERENCES
Ketamine administration in depressive disorders: a systematic review and meta-analysis
TLDR
The present meta-analysis confirms ketamine’s efficacy in depressive disorders in non-ECT studies, as well as in ECT studies, and further studies are warranted to detail efficacy in bipolar disorders and other specific depressed populations.
Is Off-label repeat prescription of ketamine as a rapid antidepressant safe? Controversies, ethical concerns, and legal implications
TLDR
Clinicians are urged to minimise the risk of harming patients by considering the empirical evidence on ketamine properties and attempting all standard antidepressant therapies before considering the off-label use of ketamine.
Ketamine safety and tolerability in clinical trials for treatment-resistant depression.
TLDR
In this relatively large group of patients with TRD, ketamine was safe and well tolerated and further research investigating the safety of ketamine in severe and refractory depression is warranted.
Ketamine use: a review.
TLDR
The implications of these findings are drawn out for treatment of ketamine-induced ulcerative cystitis in which interventions from urologists and from addiction specialists should be coordinated.
Ketamine and other glutamate receptor modulators for depression in adults.
TLDR
Among all glutamate receptor modulators, only ketamine (administered intravenously) proved to be more efficacious than placebo, though the quality of evidence was limited by risk of bias and small sample sizes.
Antidepressant effects of ketamine in depressed patients
Rapid and Longer-Term Antidepressant Effects of Repeated Ketamine Infusions in Treatment-Resistant Major Depression
Rapid antidepressant effects of repeated doses of ketamine compared with electroconvulsive therapy in hospitalized patients with major depressive disorder
Psychiatric safety of ketamine in psychopharmacology research
TLDR
Ketamine administration at subanesthetic doses appears to present an acceptable level of risk for carefully screened populations of healthy human subjects in the context of clinical research programs that intensively monitor subjects throughout their study participation.
Effects of Low-Dose and Very Low-Dose Ketamine among Patients with Major Depression: a Systematic Review and Meta-Analysis
TLDR
Low-dose ketamine appears more effective than very low dose, but there is substantial heterogeneity in clinical response, with remission among one-fifth of patients at 1 week but most others having benefits that are less durable.
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