USO DE KETAMINA COMO TRATAMIENTO PARA EL TRASTORNO DEPRESIVO REFRACTARIO: UNA REVISIÓN SISTEMÁTICA NARRATIVA
DOI:
https://doi.org/10.56238/revgeov17n3-008Palabras clave:
Ketamina, Depresión Resistente al Tratamiento, Ideación Suicida, Tratamiento, SeguridadResumen
La depresión resistente al tratamiento (TRD) afecta hasta a un tercio de los pacientes con trastorno depresivo mayor (TDM) y se asocia con altas tasas de morbilidad, ideación suicida y mortalidad. En los últimos años, la ketamina y su enantiómero esketamina han surgido como alternativas terapéuticas prometedoras debido a su rápido efecto antidepresivo mediado por el antagonismo no competitivo del receptor NMDA. El objetivo de esta revisión sistemática fue evaluar la efectividad de la ketamina en el tratamiento de la TRD, incluyendo su impacto en la ideación suicida, así como su seguridad y tolerabilidad. Por lo tanto, esta revisión narrativa se registró en la plataforma PROSPERO (CRD420250652857). Se utilizaron las bases de datos PubMed, LILACS, Cochrane y SciELO para la búsqueda y selección de artículos entre septiembre de 2024 y agosto de 2025. Se incluyeron ensayos clínicos aleatorizados y tesis publicadas en portugués e inglés entre 2020 y 2025. Dos revisores realizaron de forma independiente la selección, la extracción de datos y la evaluación del riesgo de sesgo mediante la herramienta Cochrane de Riesgo de Sesgo. De los 60 estudios identificados inicialmente, nueve cumplieron plenamente los criterios de inclusión. Los resultados mostraron que la ketamina, administrada por diferentes vías (intravenosa, intranasal e intramuscular), redujo significativamente los síntomas depresivos y la ideación suicida en comparación con placebo o controles activos (TEC, midazolam, antidepresivos). La respuesta clínica observada fue rápida, surtiendo efecto en ocasiones pocas horas después de la infusión, aunque los efectos a largo plazo siguen siendo una limitación. Los efectos adversos notificados fueron en su mayoría leves y transitorios, siendo los principales síntomas disociativos, cefalea y alteraciones cardiovasculares. A pesar de la prometedora evidencia, la heterogeneidad metodológica y el seguimiento a corto plazo constituyeron limitaciones importantes. Se necesitan ensayos clínicos a mayor escala con un seguimiento prolongado para establecer protocolos de dosis, frecuencia y mantenimiento.
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