• Jordan R Covvey, Alexis Noble Crawford, and Denise K Lowe.
• PGY1 Pharmacy Practice Resident, Virginia Commonwealth University Health System, Richmond, VA, USA.
• Ann Pharmacother. 2012 Jan 1;46(1):117-23.

ObjectiveTo evaluate the literature regarding the efficacy and safety of intravenous ketamine for treatment-resistant major depressive disorder (MDD).Data SourcesA MEDLINE search (1966-September 2011) was performed using the terms treatment-resistant depression and ketamine. The search was restricted to articles published in English and reporting on use of ketamine in humans.Study Selection And Data ExtractionAll English-language articles identified from the data search were evaluated. Data were eligible for inclusion if they were primary literature and evaluated the efficacy of ketamine for depressive symptoms in treatment-resistant MDD. One case report, 3 case series, 3 open-label trials, and 1 randomized crossover trial were included.Data SynthesisSeveral medications are available for treatment-resistant MDD; however, they are often limited by a slow onset of therapeutic effect and tolerability. It has been suggested that ketamine, a rapid-acting, N-methyl-D-aspartate glutamate receptor antagonist, may have antidepressant effects. Case reports, case series, and select trials evaluating ketamine use for depressive symptoms in treatment-resistant MDD have demonstrated a rapid effect for reductions of scores on a number of depression scales; however, its sustainability effect remains unknown. Several studies reported a large or moderate to large effect size for ketamine. Additionally, these studies showed that ketamine use in this patient population is associated with relatively well-tolerated adverse effects.ConclusionsKetamine for treatment-resistant MDD requires further evaluation before it can be considered a viable treatment option.

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