Ketamino terapija pasižymi itin dideliu efektyvumu gydymui atsparios depresijos atvejais. Klinikiniai tyrimai rodo, kad 70–80% pacientų patiria reikšmingą simptomų sumažėjimą po vienos ar kelių ketamino infuzijų, net jei anksčiau neveikė kiti vaistai. Poveikis dažnai juntamas jau per 2–24 val. ir gali išlikti nuo kelių dienų iki kelių savaičių. Remisiją (visišką simptomų išnykimą) pasiekia apie 30–50% pacientų, o greitas poveikis ypač svarbus esant suicidinėms mintims – jų sumažėjimas pastebimas jau per kelias valandas.

• Muscat, S. A., Hartelius, G., Crouch, C. R., & Morin, K. W. Optimized Clinical Strategies for Treatment-Resistant Depression: Integrating Ketamine Protocols with Trauma-and Attachment-Informed Psychotherapy. Psych (2022) 4(1), 119-141.

• Ahuja, S., Brendle, M., Smart, L., Moore, C., Thielking, P., & Robison, R. Real-world depression, anxiety and safety outcomes of intramuscular ketamine treatment: a retrospective descriptive cohort study. BMC Psychiatry (2022), 22(1), 634

• Wilkinson, Samuel T., et al. "Cognitive behavioral therapy to sustain the antidepressant effects of ketamine in treatment-resistant depression: a randomized clinical trial." Psychotherapy and psychosomatics (2021): 318-327.

• Jelen, Luke A., and James M. Stone. "Ketamine for depression." International Review of Psychiatry (2021): 207-228.

• McIntyre, Roger S., et al. "Synthesizing the evidence for ketamine and esketamine in treatment-resistant depression: an international expert opinion on the available evidence and implementation." American Journal of Psychiatry (2021): 383-399.

• Bahji, Anees, Gustavo H. Vazquez, and Carlos A. Zarate Jr. "Comparative efficacy of racemic ketamine and esketamine for depression: a systematic review and meta-analysis." Journal of affective disorders (2021): 542-555.

• Kvam, T. M., Stewart, L. H., Blomkvist, A. W., & Andreassen, O. A. “Ketamine for depression–evidence and proposals for practice.” Tidsskrift for Den norske legeforening. (2021).

• Hasler, Gregor. "Toward specific ways to combine ketamine and psychotherapy in treating depression." CNS spectrums (2020): 445-447.

• Krystal, John H., et al. "Ketamine: a paradigm shift for depression research and treatment." Neuron (2019): 774-778.

• Dore, Jennifer, et al. "Ketamine assisted psychotherapy (KAP): patient demographics, clinical data and outcomes in three large practices administering ketamine with psychotherapy." Journal of psychoactive drugs 51.2 (2019): 189-198.

• Wilkinson, Samuel T., et al. "Cognitive behavior therapy may sustain antidepressant effects of intravenous ketamine in treatment-resistant depression." Psychotherapy and psychosomatics (2017): 162-167.

• Sanacora, Gerard, et al. "A consensus statement on the use of ketamine in the treatment of mood disorders." JAMA psychiatry (2017): 399-405.

• Murrough, James W., et al. "Rapid and longer-term antidepressant effects of repeated ketamine infusions in treatment-resistant major depression." Biological psychiatry (2013): 250-256.

• Aan Het Rot, Marije, et al. "Safety and efficacy of repeated-dose intravenous ketamine for treatment-resistant depression." Biological psychiatry (2010): 139-145.

Klinikiniai tyrimai rodo, kad ketamino terapija labai greitai ir efektyviai sumažina suicidinių minčių intensyvumą. Apie 60–80% pacientų, kuriems taikoma ketamino terapija, patiria reikšmingą suicidinių minčių sumažėjimą jau per 2–24 valandas po procedūros. Šis poveikis gali išlikti nuo kelių dienų iki savaitės, o kai kuriais atvejais – ir ilgiau. Tai ypač svarbu esant ūmiai savižudybės rizikai, kai kitos priemonės neveiksmingos arba veikia per lėtai.

• Hochschild, Annabella, Michael F. Grunebaum, and J. John Mann. "The rapid anti-suicidal ideation effect of ketamine: a systematic review." Preventive medicine 152 (2021): 106524.

• Witt, Katrina, et al. "Ketamine for suicidal ideation in adults with psychiatric disorders: A systematic review and meta-analysis of treatment trials." Australian & New Zealand Journal of Psychiatry 54.1 (2020): 29-45.

• Wilkinson, Samuel T., et al. "The effect of a single dose of intravenous ketamine on suicidal ideation: a systematic review and individual participant data meta-analysis." American journal of psychiatry 175.2 (2018): 150-158.

• Wilkinson, S. T., Toprak, M., Turner, M. S., Levine, S. P., Katz, R. B., & Sanacora, G. (2017) A survey of the clinical, off-label use of ketamine as a treatment for psychiatric disorders. Am J Psychiatry, 174(7): 695–96.

• Grunebaum, Michael F., et al. "Ketamine for rapid reduction of suicidal thoughts in major depression: a midazolam-controlled randomized clinical trial." American Journal of Psychiatry 175.4 (2018): 327-335.

Vienkartinė ketamino sesija sumažina PTSS simptomų sunkumą jau per 24 val., o poveikis išlieka kelias dienas. Tyrimuose nustatytas vidutinis skirtumas pagal simptomų skalę – 12,7 balo, lyginant su placebu. Papildomai stebėtas ir depresijos simptomų mažėjimas. KAP tyrime 39–41% pacientų po 3 mėn. nebeatitiko PTSS diagnozės kriterijų.

• Abdallah, C.G., Roache, J.D., Gueorguieva, R. et al. Dose-related effects of ketamine for antidepressant-resistant symptoms of posttraumatic stress disorder in veterans and active duty military: a double-blind, randomized, placebo-controlled multi-center clinical trial. Neuropsychopharmacol. 47, 1574–1581 (2022).

• Feder, Adriana, et al. "A randomized controlled trial of repeated ketamine administration for chronic posttraumatic stress disorder." American Journal of Psychiatry (2021): 193-202.

• Ketamine For Post-Traumatic Stress Disorders And It’s Possible Therapeutic Mechanism." Neurochemistry International (2021)

• Feder, Adriana, et al. "The emergence of ketamine as a novel treatment for posttraumatic stress disorder." Advances in Pharmacology (2020): 261-286.

• Duek O, Kelmendi B, Pietrzak RH, Harpaz-Rotem I. Augmenting the treatment of PTSD with Ketamine—A review. Curr Treatment Opt Psychiatry 2019;6:143–153.

• Ross, Cassie, et al. "High-dose ketamine infusion for the treatment of posttraumatic stress disorder in combat veterans." Annals of clinical psychiatry (2019): 271-279.

• Veen, Cato, et al. "Subanesthetic dose ketamine in posttraumatic stress disorder: a role for reconsolidation during trauma-focused psychotherapy?." Behavioral neurobiology of PTSD. Springer, Cham, (2018). 137-162.

• Feder, Adriana, et al. "Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: a randomized clinical trial." JAMA psychiatry (2014): 681-688.

Apibendrinti duomenys rodo, kad ketaminas sumažina nerimo simptomus gydymui atspariais atvejais. Socialinio nerimo sutrikimo atveju, gydymo atsako tikimybė buvo 29 kartus didesnė nei placebe (OR=28,94), o poveikis gali būti ilgalaikis palaikant palaikomąjį gydymą.

• Ahuja, S., Brendle, M., Smart, L., Moore, C., Thielking, P., & Robison, R. Real-world depression, anxiety and safety outcomes of intramuscular ketamine treatment: a retrospective descriptive cohort study. BMC Psychiatry (2022), 22(1), 634

• Banov, Michael D., et al. "Efficacy and safety of ketamine in the management of anxiety and anxiety spectrum disorders: a review of the literature." CNS spectrums (2020): 331-342.

• Taylor, Jerome H., et al. "Ketamine for social anxiety disorder: a randomized, placebo-controlled crossover trial." Neuropsychopharmacology (2018): 325-333.

• Glue, Paul, et al. "Ketamine’s dose-related effects on anxiety symptoms in patients with treatment-refractory anxiety disorders." Journal of Psychopharmacology (2017): 1302-1305.

Tyrimai rodo, kad ketaminas gali trumpam sumažinti OKS simptomus, tačiau ilgalaikis poveikis nėra įrodytas. Simptomų sumažėjimas per pirmas 3 dienas po terapijos buvo mažesnis nei 12%, tačiau kartu esant depresijai, depresijos simptomai sumažėjo daugiau nei 50%.

• Sharma, Lavanya P., et al. "Clinical utility of repeated intravenous ketamine treatment for resistant obsessive-compulsive disorder." Asian journal of psychiatry (2020): 102183.

• Rodriguez, Carolyn I., et al. "Randomized controlled crossover trial of ketamine in obsessive-compulsive disorder: proof-of-concept." Neuropsychopharmacology (2013): 2475-2483.

Ketamino terapija (KAP) pacientams, sergantiems gydymui atsparia anoreksija, buvo susijęs su reikšmingu kūno masės indekso (KMI) padidėjimu ir sumažėjusiu kognityviniu rigidiškumu. Poveikis pastebimas nuo 4–5 procedūros, nepageidaujamų reiškinių nebuvo nefiksuota.

• Keeler, Johanna Louise, et al. "Ketamine as a Treatment for Anorexia Nervosa: A Narrative Review." Nutrients (2021): 4158.

• Schwartz, Terry, et al. "A longitudinal case series of IM ketamine for patients with severe and enduring eating disorders and comorbid treatment‐resistant depression." Clinical case reports (2021)

Ketamino terapija, ypač kartu su psichoterapija (KAP), padidina abstinencijos rodiklius: po vienos procedūros 22% pacientų išliko abstinentais po metų, po kelių procedūrų – net 50%. Poveikis ypač ryškus opioidų priklausomybės atveju, taip pat ženkliai sumažina potraukį.

• Kelson M, Burnett JM, Matthews A, Juneja T. “Ketamine Treatment for Alcohol Use Disorder: A Systematic Review.” Cureus. (2023) May 3;15(5):e38498

• Grabski, M., McAndrew, A., Lawn, W., Marsh, B., Raymen, L., Stevens, T., ... & Morgan, C. J. A. Adjunctive Ketamine With Relapse Prevention-Based Psychological Therapy in the Treatment of Alcohol Use Disorder. The American Journal of Psychiatry (2022).

• Mathew, Sanjay J., and Rebecca B. Price. "Ketamine Plus Motivational Enhancement Therapy: Leveraging a Rapid Effect to Promote Enduring Change." American Journal of Psychiatry 177.2 (2020): 107-109.

• Dakwar, Elias, et al. "A single ketamine infusion combined with motivational enhancement therapy for alcohol use disorder: a randomized midazolam-controlled pilot trial." American Journal of Psychiatry (2020): 125-133.

• Dakwar, Elias, et al. "A single ketamine infusion combined with mindfulness-based behavioral modification to treat cocaine dependence: a randomized clinical trial." American Journal of Psychiatry (2019): 923-930.

• Das, Ravi K., et al. "Ketamine can reduce harmful drinking by pharmacologically rewriting drinking memories." Nature communications (2019): 1-10.

• Ezquerra-Romano, I. Ivan, et al. "Ketamine for the treatment of addiction: Evidence and potential mechanisms." Neuropharmacology (2018): 72-82.

• Jones, Jennifer L., et al. "Efficacy of ketamine in the treatment of substance use disorders: a systematic review." Frontiers in psychiatry (2018)

• Dakwar, E., et al. "Cocaine self-administration disrupted by the N-methyl-D-aspartate receptor antagonist ketamine: a randomized, crossover trial." Molecular psychiatry (2017): 76-81.

• Morgan, Celia, et al. "Tripping up addiction: the use of psychedelic drugs in the treatment of problematic drug and alcohol use." Current Opinion in Behavioral Sciences (2017): 71-76.

• Krupitsky, Evgeny M., et al. "Single versus repeated sessions of ketamine-assisted psychotherapy for people with heroin dependence." Journal of psychoactive drugs (2007): 13-19.

• Krupitsky, Evgeny, et al. "Ketamine psychotherapy for heroin addiction: immediate effects and two-year follow-up." Journal of substance abuse treatment (2002): 273-283.