Cited by 408Treatment of Major DepressionElectroconvulsive Therapy StudiesTranscranial Magnetic Stimulation Studies

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Comparative efficacy of racemic ketamine and esketamine for depression: A systematic review and meta-analysis

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Bahji, Anees, Vazquez, Gustavo H., Zarate, Carlos A.·2021·Journal of Affective Disorders

DOI 10.1016/j.jad.2020.09.071PMC PMC7704936

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Abstract

Background Ketamine appears to have a therapeutic role in certain mental disorders, most notably depression. However, the comparative performance of different formulations of ketamine is less clear.Objectives This study aimed to assess the comparative efficacy and tolerability of racemic and esketamine for the treatment of unipolar and bipolar major depression.Design Systematic review and meta-analysis.Data sources We searched PubMed, MEDLINE, Embase, PsycINFO, the Cochrane Central Register of Controlled Clinical Trials, and the Cochrane Database of Systematic Reviews for relevant studies published since database inception and December 17, 2019.Study eligibility criteria We considered randomized controlled trials examining racemic or esketamine for the treatment of unipolar or bipolar major depression.Outcomes Primary outcomes were response and remission from depression, change in depression severity, suicidality, retention in treatment, drop-outs, and drop-outs due to adverse events.Analysis Evidence from randomized controlled trials was synthesized as rate ratios (RRs) for treatment response, disorder remission, adverse events, and withdrawals and as standardized mean differences (SMDs) for change in symptoms, via random-effects meta-analyses.Findings 24 trials representing 1877 participants were pooled. Racemic ketamine relative to esketamine demonstrated greater overall response (RR = 3.01 vs. RR = 1.38) and remission rates (RR = 3.70 vs. RR = 1.47), as well as lower dropouts (RR = 0.76 vs. RR = 1.37).Conclusions Intravenous ketamine appears to be more efficacious than intranasal esketamine for the treatment of depression.

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Authors: Bahji, A., Vazquez, G. H., & Zarate, C. A.
Affiliations: Queen's University (CA)
National Institutes of Health (US)
Corresponding author: Zarate, Carlos A.
ORCID: Bahji, Anees
Zarate, Carlos A.
Venue: Journal of Affective Disorders
Publisher: Elsevier BV
Published: 2021-01
Volume: 278
Pages: 542-555
ISSN: 0165-0327 (ISSN-L)
DOI: 10.1016/j.jad.2020.09.071
PMC: PMC7704936
OpenAlex: W3088001093
Cited by: 408
References: 115
Citations by year: 2026: 46 · 2025: 76 · 2024: 87 · 2023: 85 · 2022: 79 · 2021: 31
FWCI: 6.49
Type: journal article
Language: en
Update notices: erratum (2021-02-15)
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Affective Disorders (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Mental Health
Topics: Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
Keywords: ketamine, esketamine, racemic ketamine, major depressive disorder, bipolar depression, treatment response, remission, treatment discontinuation, adverse events, suicidality, intravenous administration, intranasal administration, drug efficacy comparison
MeSH terms: Antidepressive Agents, Depression, Depressive Disorder, Major, Major Depressive Disorder, Humans, Ketamine

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Comparative efficacy of racemic ketamine and esketamine for depression: A systematic review and meta-analysis

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