Cochrane · systematic review · CD011611
Ketamine and other glutamate receptor modulators for depression in adults with bipolar disorder
Dean, RL, Marquardt, T, Hurducas, C, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
33
current version
GRADE rated
22
No studies
11
Included studies
NR
No studies 11 · 33.3%Ungraded 0 · 0%Very low 15 · 45.5%Low 7 · 21.2%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyKetamine compared to placebo for adults with depression in bipolar disorder
Population: adults (aged 18 years+) with depression in bipolar disorder
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Efficacy: number of participants who respond to treatment ‐ at 24 hours Ketamine vs placebo | OR 11.61 [1.25, 107.74] | 2 studies · 33 participants | Low Downgraded: imprecision |
Efficacy: number of participants who achieve remission ‐ at 1 week Ketamine vs placebo | OR 3.35 [0.12, 93.83] | 1 study · 18 participants | Very low |
Depression rating scale score ‐ at 1 week Ketamine vs placebo | no estimate extracted | 2 studies · 28 participants | Very low |
Acceptability: total dropouts Ketamine vs placebo | OR 3.48 [0.56, 21.74] | 2 studies · 33 participants | Very low |
Acceptability: dropouts due to adverse effects Ketamine vs placebo | no estimate extracted | NR | No studies |
Ketamine compared to midazolam for adults with depression in bipolar disorder
Population: adults (aged 18 years+) with depression in bipolar disorder
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Efficacy: number of participants who respond to treatment ‐ at 24 hours Ketamine vs midazolam | OR 3.2 [0.23, 45.19] | 1 study · 16 participants | Very low Downgraded: risk of bias |
Efficacy: number of participants who achieve remission ‐ at 24 hours Ketamine vs midazolam | OR 1.33 [0.07, 25.91] | 1 study · 16 participants | Very low Downgraded: risk of bias |
Depression rating scale score ‐ at 24 hours Ketamine vs midazolam | no estimate extracted | 1 study · 16 participants | Very low Downgraded: risk of bias |
Acceptability: dropouts due to adverse effects at 24 hours Ketamine vs midazolam | no estimate extracted | 1 study · 16 participants | Very low Downgraded: risk of bias |
Acceptability: total dropouts Ketamine vs midazolam | no estimate extracted | 1 study · 16 participants | Very low Downgraded: risk of bias |
Memantine compared to placebo for adults with depression in bipolar disorder
Population: adults (aged 18 years+) with depression in bipolar disorder
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Efficacy: number of participants who respond to treatment ‐ at 1 week Memantine vs placebo | OR 1.08 [0.06, 19.05] | 1 study · 29 participants | Very low Downgraded: imprecision |
Efficacy: number of participants who respond to treatment ‐ at 2 weeks Memantine vs placebo | OR 4.88 [0.78, 30.29] | 1 study · 29 participants | Very low Downgraded: imprecision |
Efficacy: number of participants who respond to treatment ‐ at 4 weeks Memantine vs placebo | OR 5.33 [1.02, 27.76] | 1 study · 29 participants | Very low Downgraded: imprecision |
Efficacy: number of participants who respond to treatment ‐ at 3 months Memantine vs placebo | OR 1.66 [0.69, 4.03] | 2 studies · 261 participants | Low Downgraded: imprecision |
Efficacy: number of participants who achieve remission ‐ at 1 week Memantine vs placebo | OR 1.08 [0.06, 19.05] | 1 study · 29 participants | Very low Downgraded: imprecision |
Depression rating scale score ‐ at 3 months Memantine vs placebo | no estimate extracted | 1 study · 157 participants | Low |
Acceptability: total dropouts Memantine vs placebo | OR 0.77 [0.45, 1.31] | 2 studies · 261 participants | Low Downgraded: imprecision |
Acceptability: dropouts due to adverse effects Memantine vs placebo | OR 0.34 [0.01, 8.34] | 1 study · 232 participants | Low Downgraded: imprecision |
Cytidine compared to placebo for adults with depression in bipolar disorder
Population: adults (aged 18 years+) with depression in bipolar disorder
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Efficacy: number of participants who respond to treatment ‐ at 3 months Cytidine vs placebo | OR 1.13 [0.3, 4.24] | 1 study · 35 participants | Very low Downgraded: imprecision |
Efficacy: number of participants who achieve remission Cytidine vs placebo | no estimate extracted | NR | No studies |
Depression rating scale score Cytidine vs placebo | no estimate extracted | NR | No studies |
Acceptability: total dropouts Cytidine vs placebo | OR 0.94 [0.12, 7.52] | 1 study · 35 participants | Very low Downgraded: imprecision |
Acceptability: dropouts due to adverse effects Cytidine vs placebo | no estimate extracted | NR | No studies |
N‐acetylcysteine compared to placebo for adults with depression in bipolar disorder
Population: adults (aged 18 years+) with depression in bipolar disorder
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Efficacy: number of participants who respond to treatment ‐ at 3 months N‐acetylcysteine vs placebo | OR 0.82 [0.32, 2.14] | 2 studies · 69 participants | Low Downgraded: imprecision |
Efficacy: number of participants who achieve remission ‐ not reported N‐acetylcysteine vs placebo | no estimate extracted | NR | No studies |
Depression rating scale score ‐ at 3 months N‐acetylcysteine vs placebo | no estimate extracted | 2 studies · 58 participants | Low Downgraded: imprecision |
Acceptability: total dropouts ‐ not reported N‐acetylcysteine vs placebo | no estimate extracted | NR | No studies |
Acceptability: dropouts due to adverse effects ‐ not reported N‐acetylcysteine vs placebo | no estimate extracted | NR | No studies |
Riluzole compared to placebo for adults with depression in bipolar disorder
Population: Adults (aged 18 years+) with depression in bipolar disorder
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Efficacy: number of participants who respond to treatment ‐ not reported Riluzole vs placebo | no estimate extracted | NR | No studies |
Efficacy: number of participants who achieve remission ‐ not reported Riluzole vs placebo | no estimate extracted | NR | No studies |
Depression rating scale scores ‐ not reported Riluzole vs placebo | no estimate extracted | NR | No studies |
Acceptability: total dropouts Riluzole vs placebo | OR 2 [0.31, 12.84] | 1 study · 19 participants | Very low |
Acceptability: dropouts due to adverse effects ‐ not reported Riluzole vs placebo | no estimate extracted | NR | No studies |
Ketamine compared to placebo for depression in bipolar disorder in adults
Population: adults with bipolar disorder (currently experiencing a depressive episode)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Response rate ‐ at 24 hours Ketamine vs placebo | OR 11.61 [1.25, 107.74] | 2 studies · 33 participants | Low Downgraded: imprecision |
Response rate ‐ at 3 days Ketamine vs placebo | OR 8.24 [0.84, 80.61] | 2 studies · 33 participants | Very low |
Response rate ‐ at 1 week Ketamine vs placebo | OR 4 [0.33, 48.66] | 1 study · 18 participants | Very low |
Remission rate ‐ at 1 week Ketamine vs placebo | OR 3.35 [0.12, 93.83] | 1 study · 18 participants | Very low |
Depression rating scale score at 1 week Ketamine vs placebo | no estimate extracted | 2 studies · 28 participants | Very low |
Acceptability ‐ total dropouts Ketamine vs placebo | OR 3.48 [0.56, 21.74] | 2 studies · 33 participants | Very low |
Acceptability ‐ dropouts due to adverse effects Ketamine vs placebo | no estimate extracted | NR | No studies |
Memantine compared to placebo for depression in bipolar disorder in adults
Population: adults with bipolar disorder (currently experiencing a depressive episode)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Response rate ‐ at 1 week Memantine vs placebo | OR 1.08 [0.06, 19.05] | 1 study · 29 participants | Very low Downgraded: imprecision |
Response rate ‐ at 2 weeks Memantine vs placebo | OR 4.88 [0.78, 30.29] | 1 study · 29 participants | Very low Downgraded: imprecision |
Response rate ‐ at 4 weeks Memantine vs placebo | OR 5.33 [1.02, 27.76] | 1 study · 29 participants | Very low Downgraded: imprecision |
Response rate ‐ at 3 months Memantine vs placebo | OR 1.66 [0.69, 4.03] | 2 studies · 261 participants | Low Downgraded: imprecision |
Remission rate ‐ at 1 week Memantine vs placebo | OR 1.08 [0.06, 19.05] | 1 study · 29 participants | Very low Downgraded: imprecision |
Depression rating scale score at 3 months Memantine vs placebo | no estimate extracted | 1 study · 157 participants | Low Downgraded: imprecision |
Acceptability ‐ total dropouts Memantine vs placebo | OR 0.77 [0.45, 1.31] | 2 studies · 261 participants | Low Downgraded: imprecision |
Acceptability ‐ dropouts due to adverse events Memantine vs placebo | OR 0.34 [0.01, 8.34] | 1 study · 232 participants | Low Downgraded: imprecision |
Cytidine compared to placebo for depression in bipolar disorder in adults
Population: adults with bipolar disorder (currently experiencing a depressive episode)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Response rate ‐ at 3 months Cytidine vs placebo | OR 1.13 [0.3, 4.24] | 1 study · 35 participants | Very low Downgraded: imprecision |
Acceptability ‐ total dropouts Cytidine vs placebo | OR 0.94 [0.12, 7.52] | 1 study · 35 participants | Very low Downgraded: imprecision |
Remission Cytidine vs placebo | no estimate extracted | NR | No studies |
Depression rating scale score Cytidine vs placebo | no estimate extracted | NR | No studies |
Acceptability ‐ dropouts due to adverse events Cytidine vs placebo | no estimate extracted | NR | No studies |