The Journal of clinical psychiatry
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Intravenous (IV) ketamine has rapid and robust antidepressant effects; however, poor accessibility of the IV route often limits its use. Numerous alternative routes of administration are being investigated. Oral ketamine is particularly appealing for its ease of use with the potential for high accessibility. The objective of the current systematic review, in accordance with PRISMA, is to determine the efficacy, safety, tolerability, and dose range of oral ketamine for bipolar and unipolar depression. ⋯ A small number of clinical studies assessed the antidepressant effects of oral ketamine. Initial results suggest that oral ketamine has significant antidepressant effects with good overall tolerability; however, antidepressant effects are not as rapid as those associated with IV ketamine. Antisuicide effects and efficacy in treatment-resistant depression have yet to be demonstrated. Additional well-designed RCTs are warranted.