Efficacy of ketamine and esketamine on functional outcomes in treatment-resistant depression: A systematic review.

Jul 5, 2021Journal of affective disorders

Ketamine and esketamine's effects on daily functioning in hard-to-treat depression

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Abstract

Four randomized-controlled trials reported on the efficacy of ketamine/esketamine treatment for functional outcomes in adults with treatment-resistant depression.

Mixed results were observed regarding the effects of ketamine/esketamine on various functional measures, including psychosocial and workplace functioning.
One study reported a significant decrease in the Sheehan Disability Scale total scores, indicating improved functioning with esketamine treatment.
Most studies did not focus on functional outcomes as primary measures, limiting the overall understanding of these treatments' impacts.
Evaluations of work or social-related disability were often secondary outcomes using subjective rating scales.
The relationship between symptomatic improvement and functional improvement remains uncertain and warrants further investigation.

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BACKGROUND: In recent years, ketamine and esketamine treatment have demonstrated rapid antidepressant effects in adults with treatment-resistant depression (TRD). Hitherto, relatively few studies have reported the effect of ketamine/esketamine treatment on functional outcomes (e.g., psychosocial functioning, workplace functioning). Herein, we review and synthesize extant literature reporting functional outcomes with ketamine/esketamine treatment in adults with TRD.

METHODS: A systematic review of clinical studies reporting subjective or objective ratings of general functioning as primary or secondary outcomes was performed.

RESULTS: Four randomized-controlled trials, one open-label clinical study and one case series reported on the efficacy of ketamine/esketamine on subjective measures of general functioning. Overall, mixed results were reported with respect to the effect across disparate functional measures (e.g., Sheehan Disability Scale [SDS]) using ketamine/esketamine. A single study demonstrated a significant decrease (i.e., improvement) in SDS total scores in TRD with esketamine treatment; most studies, however, did not report on functional outcomes and have functional outcomes as a (co)-primary outcome measure.

LIMITATIONS: Clinical studies that were included evaluated work- or social-related disability as a secondary outcome using subjective rating scales.

CONCLUSION: Functional outcomes in adults with TRD receiving ketamine/esketamine was insufficiently characterized. Available evidence indicates that improvements in general psychosocial functioning is apparent. The association, if any, between symptomatic improvement and functional improvement in TRD, as well as the temporality to improve functioning, are future research vistas.

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Efficacy of ketamine and esketamine on functional outcomes in treatment-resistant depression: A systematic review.

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