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      The efficacy and safety of ketamine for depression in patients with cancer: A systematic review

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          Abstract

          Background

          Management of depression in the oncology population includes supportive psychotherapeutic interventions with or without psychotropic medication, which take time to demonstrate effectiveness. Fast-acting interventions, like ketamine, can provide a rapid antidepressant effect; however, there has been limited research on effects of ketamine among cancer patients. The objective of this review is to provide an overview of research on the efficacy and safety of ketamine on depression in patients with cancer.

          Methods

          We reviewed the published literature in MEDLINE® (via PubMed®), EMBASE, and Scopus from 1 January 1982 to 20 October 2022. We screened the retrieved abstracts against inclusion criteria and conducted a full‐text review of eligible studies. Following extraction of data from included studies, we used a framework analysis approach to summarize the evidence on using ketamine in patients with cancer.

          Results

          All 5 included studies were randomized clinical trials conducted in inpatient settings in China. In all included studies ketamine was administered intravenously. Three studies used only racemic ketamine, and two studies used both S-ketamine and racemic ketamine. All included studies reported ketamine a tolerable and effective drug to control depression symptoms.

          Conclusion

          Included studies showed administration of sub-anesthesia ketamine significantly improves postoperative depression among patients with cancer.

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          Most cited references42

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          The Effect of a Single Dose of Intravenous Ketamine on Suicidal Ideation: A Systematic Review and Individual Participant Data Meta-Analysis

          Objective Suicide is a public health crisis with limited treatment options. We conducted a systematic review and individual participant data meta-analysis examining the effects of a single dose of ketamine on suicidal ideation. Method Individual participant data were obtained from 10 of 11 identified comparison intervention studies (using either saline or midazolam as control). The analysis included only participants with suicidal ideation at baseline (n=167). A one-stage, individual participant data, meta-analytic procedure was employed using a mixed-effects, multilevel, general linear model. The primary outcome measures were the suicide items from clinician-administered (Montgomery-Asberg Depression Rating Scale (MADRS) or Hamilton Depression Rating Scale (HAM-D)) and self-reported scales (Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR) or Beck Depression Inventory (BDI)), obtained for up to one week post-ketamine administration. Results Ketamine rapidly reduced (one day) suicidal ideation on both the clinician-administered (p<0.001) and self-reported outcome measures (p<0.001). Effect sizes were moderate-to-large (Cohen’s d=0.51–0.85) at all time points post-dose. Sensitivity analysis demonstrated that, compared to controls, ketamine had significant benefits on the individual suicide items of the MADRS, HAM-D, and QIDS-SR (all p<0.001) but not on the BDI (p=0.080). Ketamine’s effect on suicidal ideation remained significant after adjusting for concurrent changes in severity of depressive symptoms. Conclusions Ketamine rapidly reduced suicidal thoughts within one day and for up to one week in depressed patients with suicidal ideation. Ketamine’s effects on suicidal ideation were partially independent of its effects on mood, though subsequent trials in transdiagnostic samples are required to confirm that ketamine exerts a specific effect on suicidal ideation. Additional research on ketamine’s long-term safety and its efficacy in reducing suicide risk is needed before clinical implementation.
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            Depression and anxiety in relation to cancer incidence and mortality: a systematic review and meta-analysis of cohort studies

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              Depression and anxiety in patients with cancer

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                Author and article information

                Contributors
                Journal
                Int J Clin Health Psychol
                Int J Clin Health Psychol
                International Journal of Clinical and Health Psychology : IJCHP
                Asociacion Espanola de Psicologia Conductual
                1697-2600
                2174-0852
                15 December 2023
                Jan-Mar 2024
                15 December 2023
                : 24
                : 1
                : 100428
                Affiliations
                [a ]University of South Florida Morsani College of Medicine, Tampa, FL, United States
                [b ]College of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
                [c ]Department of Clinical Science and Nutrition, University of Chester, England
                [d ]University of South Florida Health Libraries Morsani University of South Florida Morsani College of Medicine, Tampa, FL, United States
                [e ]Supportive Care Medicine Department, Behavioral Medicine Services, Moffitt Cancer Center, Tampa, FL, United States
                [f ]Department of Psychiatry and Behavioral Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, United States
                [g ]Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, United States
                [h ]Department of Anesthesiology, Moffitt Cancer Center, Tampa, FL, United States
                [i ]Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
                [j ]Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, United States
                Author notes
                [* ]Corresponding author at: 12902 USF Magnolia Drive, Tampa, FL 33612. amir.alishahi@ 123456moffitt.org
                Article
                S1697-2600(23)00064-9 100428
                10.1016/j.ijchp.2023.100428
                10764987
                38179461
                b254ec54-c662-43a9-8c15-4b73979afc95
                © 2023 The Author(s)

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 2 October 2023
                : 6 December 2023
                Categories
                Original Article

                ketamine,cancer,depression,antidepressant,systematic review
                ketamine, cancer, depression, antidepressant, systematic review

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