The effect of ketamine on cognition, anxiety, and social functioning in adults with psychiatric disorders: A systematic review and meta-analysis

Mattia Marchi; Federica Maria Magarini; Giacomo Galli; Federico Mordenti; Antonio Travascio; Daniele Uberti; Edoardo De Micheli; Luca Pingani; Silvia Ferrari; Gian Maria Galeazzi

doi:10.3389/fnins.2022.1011103

The effect of ketamine on cognition, anxiety, and social functioning in adults with psychiatric disorders: A systematic review and meta-analysis

Front Neurosci. 2022 Nov 24:16:1011103. doi: 10.3389/fnins.2022.1011103. eCollection 2022.

Authors

Mattia Marchi^{1

2}, Federica Maria Magarini³, Giacomo Galli⁴, Federico Mordenti¹, Antonio Travascio¹, Daniele Uberti¹, Edoardo De Micheli¹, Luca Pingani^{1

2}, Silvia Ferrari^{1

2}, Gian Maria Galeazzi^{1

2}

Affiliations

¹ Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
² Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
³ Department of Mental Health and Drug Abuse, Azienda Unità Sanitaria Locale (AUSL) Modena, Modena, Italy.
⁴ Villa Igea Psychiatric Hospital, Modena, Italy.

Abstract

Background: It has been shown that ketamine can improve suicidality and depression. Evidence for other dimensions of psychopathology is lacking. We undertook a systematic review to investigate the effect of ketamine on cognition, anxiety, quality of life, and social functioning in adults with psychiatric disorders.

Methods: PubMed (Medline), Scopus, PsycINFO, and EMBASE were searched up to April 2022. Randomized controlled trials (RCTs) on ketamine [or its S (+) enantiomer] reporting data on cognition, anxiety, quality of life, social functioning in adults with psychiatric disorders were included. Standardized mean difference (SMD) was used for summarizing continuous outcomes.

Results: Twenty-two reports were included in the final selection, of which 20, corresponding to 1,298 participants, were included in the quantitative synthesis. Affective disorders were the predominant diagnostic category. Median follow-up time was 21 days. The evidence was rated moderate to very low. In most trials, ketamine was administered intravenously or as adjuvant to electro-convulsant therapy (ECT). Only 2 trials of intranasal esketamine were identified. The effect of ketamine on depression was confirmed (SMD: -0.61 [95% CI: -1.06; -0.16]). Furthermore, by pooling results of 6 RCTs, ketamine may be effective in reducing anxiety symptoms (SMD: -0.42 [95% CI: -0.84; 0.003]), particularly when administered not within ECT (5 trials; SMD: -0.58 [95% CI: -1.07; -0.09]). However, there was moderate heterogeneity of results. Patients treated with ketamine also had an improvement in social functioning (SMD: -0.31 [95% CI: -0.52; -0.10]), although the estimate was based only on 2 studies. No difference to comparators was found with respect to cognition and quality of life.

Conclusion: Alongside the antidepressant effect, ketamine may also improve anxiety and social functioning in adults with affective disorders.

Keywords: anxiety; cognition; depression; esketamine; ketamine; social functioning.

Publication types

Systematic Review