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Review
. 2023 Apr 10;16(4):568.
doi: 10.3390/ph16040568.

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

Aleksander Kwaśny  1 , Adam Włodarczyk  1 , Damian Ogonowski  1 , Wiesław Jerzy Cubała  1
Affiliations
Review

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

Aleksander Kwaśny et al. Pharmaceuticals (Basel). .

Abstract

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: arketamine; circadian rhythm; depression; esketamine; hypersomnia; insomnia; ketamine; ketamine metabolites; major depressive disorder.

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Conflict of interest statement

Damian Ogonowski has no conflict of interest. Aleksander Kwaśny has received research support from MSD. Adam Włodarczyk has received research support from Actavis, Eli Lilly, Minerva Neurosciences, Sunovion Pharmaceuticals, KCR, Janssen, Otsuka, Apodemus, Cortexyme, and Acadia. Wiesław Jerzy Cubała has received research support from Acadia, Alkermes, Allergan, Angelini, Auspex Pharmaceuticals, BMS, Celon, Cephalon, Cortexyme, Ferrier, Forest Laboratories, Gedeon Richter, GWPharmaceuticals, HMNC Brain Health, IntraCellular Therapies, Janssen, KCR, Lilly, Lundbeck, Minerva, MSD, NIH, Novartis, Orion, Otsuka, Sanofi, and Servier. Honoraria: Adamed, Angelini, AstraZeneca, BMS, Celon, GSK, Janssen, KRKA, Lekam, Lundbeck, Minerva, NeuroCog, Novartis, Orion, Pfizer, Polfa Tarchomin, Douglas Pharm., Sanofi, Servier, and Zentiva. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flow chart representing the search strategy and the process of including studies for analysis.
Figure 2
Figure 2
Risk of bias for randomised studies with the RoB 2 tool [29,41,42].
See this image and copyright information in PMC

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