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Effect of Ketamine on Sleep in Treatment-Resistant Depression: A Systematic Review

Autores: Aleksander Kwaśny, Adam Włodarczyk, Damian Ogonowski, Wiesław Jerzy Cubała

Department of Psychiatry, Faculty of Medicine, Medical University of Gdansk, 80-214 Gdańsk, Poland
Resumo: A ketamina contribui para a redução dos sintomas de insónia sem potenciais efeitos de hipersónia. As mudanças no sono servem de mediação a respostas anti-depressivas e anti-suicidas. Foram observadas melhorias nos valores EEG (SWS, SWA, tempo TS e acordar noturno). Os dados dos padrões de sono em pacientes a tomar ketamina são pontuais e surgem como resultados secundários. Este estudo deverá ser visto como um estudo-piloto para resolução de problemas de sono em pacientes TRD. É necessário recolher mais dados clínicos colocando o sono como objeto principal das medições.
Pharmaceuticals 202316(4), 568;
Received: 16 February 2023 / Revised: 4 April 2023 / Accepted: 7 April 2023 / Published: 10 April 2023
Background: Depression is a debilitating disease with a high socioeconomic burden. Regular antidepressants usually require several weeks to ameliorate symptoms; however, numerous patients do not achieve remission. What is more, sleep disturbances are one of the most common residual symptoms. Ketamine is a novel antidepressant with rapid onset of action with 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 research the impact ketamine has 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. Preferred Reporting Items for Systematic Reviews and Meta-Analyses 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 measured by MADRS (Montgomery–Åsberg Depression Rating Scale) and QIDS-SR16 (Quick Inventory of Depressive Symptomatology Self-Report (16-item)) scales after intravenous ketamine and intranasal esketamine administration. One case report showed mitigation of symptoms in PSQI (Pittsburgh Sleep Quality Index) and ISI (Insomnia Severity Index) during 3-month 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 sleep 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
(Foto de Alexander Grey na Unsplash)