Therapeutic Protocols Using Ketamine and Esketamine for Depressive Disorders: A Systematic Review.

Depression is a widespread mental health disorder that causes severe emotional suffering and increases suicide risk. Ketamine and esketamine have expanded treatment options. A systematic review following PRISMA criteria analyzed existing protocols for treating depression with these substances. Results showed a predominance of medical approaches, with few studies on ketamine-assisted psychotherapy or other psychedelic-assisted therapies. Limited information was reported on psychosocial elements like preparation, psychological support during sessions, and integration of experiences. These findings suggest that treatment practices for depression with ketamine or esketamine diverge from those used with other psychedelic substances, highlighting directions for future research.

Study at a glance

Abstract

Depression is one of the most prevalent mental health disorders globally, causing severe emotional suffering, reducing life expectancy and increasing the risk of suicide. Recently, the use of dissociative psychedelic substances such as ketamine and esketamine for depressive disorders has expanded treatment options. We sought to analyze, through a systematic review, the existing protocols for the treatment of depression with ketamine and esketamine. The search adopted PRISMA criteria and was performed using PubMed and Web of Science databases. Procedures in each study were compared, focusing on the sample recruited, therapeutic approaches, including the clinical team and professionals engaged in treatment, medical procedures, description of the setting (including music) and factors such as specific medication (ketamine or esketamine), route of administration and dosage employed. Results indicated the predominance of a medical approach, with a limited number of studies on ketamine assisted psychotherapy (KAP) and other modalities of psychedelic assisted therapy. Additionally, there is limited information on psychosocial elements such as preparation, psychological support during session and integration of experience. Altogether these findings suggest that treatment of depression with ketamine or esketamine diverges in relation to the practices employed with psychedelic substances. This is discussed considering future research directions in the field.