Effect of Perioperative Ketamine on Postoperative Mood and Depression: A Review of the Literature

ABSTRACT

Introduction: Ketamine is being increasingly utilized in a variety of patient care settings, ranging from high acuity inpatient scenarios to the outpatient management of select mental health diagnoses. Postoperative patients are at an increased risk of developing a depressed state, and though ketamine’s ability to improve mood is well documented in the literature, the relationship between perioperative ketamine and postoperative mood has not been fully elucidated.

Areas covered: The purpose of this review was to determine ketamine’s ability to improve mood and depression scores in the perioperative setting. A comprehensive literature review was conducted using PubMed, MEDLINE, Scopus, ProQuest, Web of Science, and CINAHL using the following search terminology: ‘ketamine’ AND ‘perioperative’ OR ‘surgery’ AND ‘mood’ OR ‘depression.’ Seven clinical trials are evaluated in this review.

Expert opinion: As the use of ketamine continues to expand, clinicians must be cognizant of the fact that many of its desired effects are likely to overlap. Patients outside of the perioperative setting may benefit from using ketamine as an analgesic or sedative, as appropriate, to mitigate mood and depression. Ketamine, when administered as an anesthetic in the perioperative setting, seemingly has effect on postoperative mood and depression. Further studies that are sufficient.

KEYWORDS:

• Ketamine
• depression
• analgesia
• postoperative
• clinical pharmacy

Article highlights

• Review of ketamine’s mechanisms of action as related to depression and analgesia

• Historic review of postoperative depression and associated risk factors.

• Presentation and critique of clinical trials designed to evaluate the effect of ketamine on postoperative depression.

• Evaluation of depression rating scales as they relate to the outcomes of clinical trials.

• Discussion of dosing strategies and safety concerns for ketamine.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer has declared being the inventor and patent owner of the use of arketamine in the treatment of depression. All other peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.