Effect of Ketamine on Sleep in Treatment-Resistant Depression: A Systematic Review
https://doi.org/10.3390/ph16040568
Authors: Aleksander Kwaśny, Adam Włodarczyk, Damian Ogonowski, Wiesław Jerzy Cubała
Received: February 16, 2023 / Revised: April 4, 2023 / Accepted: April 7, 2023 / Published: April 10, 2023
Abstract
Background: Depression is a debilitating disease with a high socioeconomic burden. Conventional antidepressants typically take several weeks to alleviate symptoms; however, many patients do not achieve remission. Furthermore, sleep disturbances are one of the most common residual symptoms. Ketamine is a novel antidepressant with a rapid onset of action and a proven antisuicidal effect. Little is known about its impact on sleep–wake and circadian rhythm alterations. The aim of this systematic review is to investigate the impact of ketamine on sleep disturbances in depression. Methods: PubMed, Web of Science, and APA PsycINFO were searched for relevant studies on ketamine’s impact on sleep disturbances in depression. The PRISMA2020 methodology was applied. The systematic review protocol was registered in the PROSPERO Registry (CRD42023387897). Results: Five studies were included in this review. Two studies reported significant improvement in sleep as measured by the MADRS (Montgomery–Åsberg Depression Rating Scale) and QIDS-SR16 (Quick Inventory of Depressive Symptomatology Self-Report (16-item)) scales following intravenous ketamine and intranasal esketamine administration. One case report showed a reduction in symptoms on the PSQI (Pittsburgh Sleep Quality Index) and ISI (Insomnia Severity Index) during 3 months of treatment with esketamine. In two studies, sleep was objectively measured by nocturnal EEG (electroencephalography) and showed a decrease in nocturnal wakefulness accompanied by an increase in slow-wave (SWS) and rapid eye movement (REM) sleep. Conclusion: Ketamine reduces the severity of insomnia in depression. Robust data are lacking. More research is needed.
Background: Depression is a debilitating disease with a high socioeconomic burden. Conventional antidepressants typically take several weeks to alleviate symptoms; however, many patients do not achieve remission. Furthermore, sleep disturbances are one of the most common residual symptoms. Ketamine is a novel antidepressant with a rapid onset of action and a proven antisuicidal effect. Little is known about its impact on sleep–wake and circadian rhythm alterations. The aim of this systematic review is to investigate the impact of ketamine on sleep disturbances in depression. Methods: PubMed, Web of Science, and APA PsycINFO were searched for relevant studies on ketamine’s impact on sleep disturbances in depression. The PRISMA2020 methodology was applied. The systematic review protocol was registered in the PROSPERO Registry (CRD42023387897). Results: Five studies were included in this review. Two studies reported significant improvement in sleep as measured by the MADRS (Montgomery–Åsberg Depression Rating Scale) and QIDS-SR16 (Quick Inventory of Depressive Symptomatology Self-Report (16-item)) scales following intravenous ketamine and intranasal esketamine administration. One case report showed a reduction in symptoms on the PSQI (Pittsburgh Sleep Quality Index) and ISI (Insomnia Severity Index) during 3 months of treatment with esketamine. In two studies, sleep was objectively measured by nocturnal EEG (electroencephalography) and showed a decrease in nocturnal wakefulness accompanied by an increase in slow-wave (SWS) and rapid eye movement (REM) sleep. Conclusion: Ketamine reduces the severity of insomnia in depression. Robust data are lacking. More research is needed.
Keywords: ketamine; esketamine; arketamine; ketamine metabolites; insomnia; hypersomnia; circadian rhythm; depression; major depressive disorder
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