USO DA CETAMINA COMO TRATAMENTO DE TRANSTORNO DEPRESSIVO REFRATÁRIO: UMA REVISÃO SISTEMÁTICA NARRATIVA
DOI:
https://doi.org/10.56238/revgeov17n3-008Palavras-chave:
Cetamina, Depressão Resistente ao Tratamento, Ideação Suicida, Tratamento, SegurançaResumo
A depressão resistente ao tratamento (DRT) afeta até um terço dos pacientes com transtorno depressivo maior (TDM) e está associada a altas taxas de morbidade, ideação suicida e mortalidade. Em anos recentes, a cetamina e seu enantiômero escetamina emergiram como alternativas terapêuticas promissoras, devido ao seu rápido efeito antidepressivo mediado pelo antagonismo não competitivo do receptor NMDA. O objetivo desta revisão sistemática foi avaliar a efetividade da cetamina no tratamento da DRT, incluindo seu impacto sobre a ideação suicida, além de sua segurança e tolerabilidade. Assim, essa revisão narrativa foi registrada na plataforma PROSPERO (CRD420250652857). Foram utilizadas as bases de dado PubMed, LILACS, Cochrane e SciELO para realizar a pesquisa e seleção de artigos entre setembro de 2024 e agosto de 2025. Foram incluídos ensaios clínicos randomizados e teses publicadas em português e inglês entre 2020 e 2025. Dois avaliadores realizaram, de forma independente, a triagem, extração de dados e avaliação do risco de viés por meio da ferramenta Cochrane Risk of Bias. Dos 60 estudos inicialmente identificados, nove preencheram os critérios de inclusão em sua totalidade. Os resultados evidenciaram que a cetamina, em diferentes vias de administração (intravenosa, intranasal e intramuscular), causou redução significativa dos sintomas depressivos e da ideação suicida quando em comparação a placebo ou controles ativos (ECT, midazolam, antidepressivos). A resposta clínica observada foi rápida, tendo efeito, por vezes, poucas horas após a infusão, embora os efeitos de longo prazo permaneçam sendo uma limitação. Os efeitos adversos relatados foram em sua maioria leves e transitórios, sendo os principais os sintomas dissociativos, a cefaleia e as alterações cardiovasculares. Apesar das evidências promissoras, a heterogeneidade metodológica e o seguimento de curto prazo nos foram limitações importantes. Ensaios clínicos de maior escala e com acompanhamento prolongado são necessários para estabelecer protocolos de dose, frequência e manutenção.
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