Oral ketamine for the treatment of pain and treatment-resistant depression

Background
Recent studies with intravenous (i.v.) application of
ketamine show remarkable but short-term success in
patients with MDD. Studies in patients with chronic pain
have used different ketamine applications for longer time
periods. This experience may be relevant for psychiatric
indications.
Aims
To review the literature about the dosing regimen, duration,
effects and side-effects of oral, intravenous, intranasal and
subcutaneous routes of administration of ketamine for
treatment-resistant depression and pain.
Method
Searches in PubMed with the terms ‘oral ketamine’,
‘depression’, ‘chronic pain’, ‘neuropathic pain’, ‘intravenous
ketamine’, ‘intranasal ketamine’ and ‘subcutaneous
ketamine’ yielded 88 articles. We reviewed all papers for
information about dosing regimen, number of individuals who
received ketamine, number of ketamine days per study,
results and side-effects, as well as study quality.
Results
Overall, the methodological strength of studies investigating
the antidepressant effects of ketamine was considered low,
regardless of the route of administration. The doses for
depression were in the lower range compared with studies
that investigated analgesic use. Studies on pain suggested
that oral ketamine may be acceptable for treatment-resistant
depression in terms of tolerability and side-effects.
Conclusions
Oral ketamine, given for longer time periods in the described
doses, appears to be well tolerated, but few studies have
systematically examined the longer-term negative
consequences. The short- and longer-term depression
outcomes as well as side-effects need to be studied with
rigorous randomised controlled trials.

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