Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant


Physician Assistant Studies


Objective: The objective of this selective EBM review is to determine whether or not ketamine is effective in reducing depressive symptoms in adults with treatment-resistant major depressive disorder.

Study Design: A systematic review of 3 randomized, double-blind placebo controlled trials performed in or after the year 2016.

Data Sources: All 3 studies published in peer-reviewed journals found on PubMed and Cochrane Collection.

Outcome Measures: The studies utilized quantitative scales, either the Montgomery-Asberg Depression Scale (MADRS) or Hamilton Depression Rating Scales (HAMD) for the POEM, depressive symptoms.

Results: George et al. (Am J Geriatr Psychiatry. 2017;25(11):1199-1209. doi: 10.1016/j.jagp.2017.06.007) did show significant reduction in depressive symptoms with 0.2mg/kg ketamine SQ and the severity of the depressive episode downgraded compared to the placebo of midazolam at day 2 and induced remission in some individuals. Chen et al. (J Affect Disord. 2018;225:709-714. doi: 10.1016/j.jad.2017.09.008) additionally found a significant change in depressive symptoms from 0.2mg/kg ketamine infusion compared to the placebo. However, Su et al. (Neuropsychopharmacology. 2017;42(13):2482-2492. doi: 10.1038/npp.2017.94) results of 0.2mg/kg ketamine displayed near equal reduction between the intervention and placebo of saline solution at day 2.

Conclusion: This EBM shows that more studies need to be performed before one could recommend ketamine as an intervention for treatment resistant MDD. The reductions in the short term were significant and encourage the capability of ketamine as a bridge therapy or short term episodic treatment.