Intravenous Ketamine vs. Intranasal Esketamine for Depression: A Systematic Review and Meta-Analysis

Abstract

This systematic review and meta-analysis is designed to comprehensively evaluate the comparative efficacy and safety of intravenous ketamine (IV-KET) versus intranasal esketamine (IN-ESKET) in treating treatment-resistant depression in adults diagnosed with major depressive disorder or bipolar depression. The project seeks to synthesize data from both randomized controlled trials and observational studies that directly compare these two modalities, focusing on primary outcomes such as remission and response rates, time to remission, and the number of treatments required to achieve clinical improvement, while also examining secondary outcomes including adverse effects (e.g., dissociative symptoms, cardiovascular changes, sedation, and gastrointestinal side effects), dropout rates, relapse or durability of response, and improvements in functional outcomes or quality of life. To ensure a comprehensive and unbiased review, a broad search strategy will be employed across multiple databases without language or publication date restrictions, including peer-reviewed literature and grey literature such as conference abstracts, with all records managed using EndNote and Covidence to facilitate systematic screening, duplicate data extraction by independent reviewers, and rigorous risk-of-bias assessments using established tools like the Cochrane Risk of Bias 2 tool for RCTs and the Newcastle-Ottawa Scale for observational studies. Quantitative synthesis will be performed using a random-effects meta-analysis when data allow, and where heterogeneity exists, a narrative synthesis will provide context and detail, ultimately aiming to inform clinical decision-making and guide future research by elucidating whether IV-KET or IN-ESKET offers superior outcomes for individuals with treatment-resistant depression.

Topics & conditions

Detected automatically by Psychedelic Commons from the title and abstract, not labels from the source. They may be incomplete.

Keywords