Journal of Affective Disorders ( IF 6.6 ) Pub Date : 2022-07-26 , DOI: 10.1016/j.jad.2022.07.030 Isak Joneborg 1 , Yena Lee 2 , Joshua D Di Vincenzo 2 , Felicia Ceban 3 , Shakila Meshkat 4 , Leanna M W Lui 5 , Farhan Fancy 6 , Joshua D Rosenblat 7 , Roger S McIntyre 8
Background
Few studies have evaluated the efficacy of ketamine-assisted psychotherapy (KAP) in the treatment of treatment-resistant depression (TRD) and substance use disorders (SUD).
Methods
A systematic review of clinical trials reporting on the efficacy of KAP and discussing mechanisms of action, identified on PubMed and PsycInfo.
Results
Five randomized-controlled trials reported on the efficacy of KAP treatment and discussed active mechanisms. Four of the studies treated adults with SUD and a single study treated adults with TRD. Overall, KAP had a significant positive effect on primary outcome measures compared to controls, however, the data is mixed. The study examining KAP for TRD found no benefit.
Limitations
Lack of large, replicated clinical trials. No studies actively examining mechanisms of action.
Conclusion
Evidence suggests that temporary neural changes caused by ketamine such as n-methyl-d-aspartate receptor (NMDAR) inhibition and increase of synaptic neuroplasticity affect treatment outcomes of KAP. Based on reports of preliminary findings, we speculate that adjunct psychotherapy, changes in perspective, and spirituality may also play a role.
中文翻译:
氯胺酮辅助心理治疗的积极机制:系统评价
背景
很少有研究评估氯胺酮辅助心理疗法 (KAP) 在治疗难治性抑郁症 (TRD) 和物质使用障碍 (SUD) 中的疗效。
方法
在 PubMed 和 PsycInfo 上确定的关于 KAP 功效的临床试验报告和讨论作用机制的系统评价。
结果
五项随机对照试验报告了 KAP 治疗的疗效并讨论了积极机制。其中四项研究治疗了患有 SUD 的成人,一项研究治疗了患有 TRD 的成人。总体而言,与对照组相比,KAP 对主要结果测量具有显着的积极影响,但数据好坏参半。检查 KAP 对 TRD 的研究没有发现任何益处。
限制
缺乏大型、重复的临床试验。没有研究积极检查作用机制。
结论
有证据表明,氯胺酮引起的暂时性神经变化,例如n-甲基-d-天冬氨酸受体 (NMDAR) 抑制和突触神经可塑性增加会影响 KAP 的治疗结果。根据初步调查结果的报告,我们推测辅助心理治疗、观点的改变和灵性也可能发挥作用。