Análise da eficácia e segurança do uso da cetamina endovenosa na depressão unipolar resistente ao tratamento: revisão sistemática de ensaios clínicos randomizados

Abstract

Objective: To evaluate the results associated with the efficacy and safety of the therapeutic use of ketamine in treatment-resistant depression (TRD) Introduction: Depression is the leading cause of disability worldwide.TRD is characterized by a lack of response to initial and conventional therapy. The lack of effective drugs with rapid action increases the number of cases of individuals who develop TRD. Ketamine has been increasingly studied as a therapeutic alternative Methods: Systematic Review using databases (PubMed, SciELO, LILACS e EMBASE) for the collection of randomized clinical trials evaluating the efficacy and safety of the use of ketamine on TRD. The studies were subjected to a selection by title and, later, by the reading of the abstracts. These selected articles were read for complete evaluation and verification of eligibility, according to the inclusion and exclusion criteria. Results: Six randomized controlled trials were selected. For studies evaluating the efficacy, all were clinically beneficial after drug use. For the studies that evaluated the acceptability/safety of the drug, the occurrence of adverse symptoms was transient and without recurrence. Discussion: The ketamine in TRD was associated with rapid and robust pharmacological action, after a single infusion, and could be maintained for up to 7 days. Alternating two or three times a week, maintenance of effects has been reported for an average of 30 days. The S-ketamine appears to have antidepressant effects similar to the racemic one. Suicidal ideation showed a rapid decline, after a single infusion of ketamine, and may consider the drug a potential alternative for suicidal risk control. Conclusion: The present review evidenced the promising efficacy and safety of ketamine in subjects with TRD, but there are still challenges in the clinical application that require further analysis and research, in order to decide on the definitives validation of the drug.