Ketamine treatment for depression: a review

Summary & key facts

Ketamine can bring fast relief from depression for some people. A single low-dose infusion often reduces symptoms within one day, but the effect usually fades after about three to seven days. A related nasal spray, called esketamine, was approved in 2019 as an add-on for adults whose depression did not get better with other treatments, and it must be given under medical supervision. Short-term side effects are common but usually happen around the time of treatment, and we do not yet know much about long-term risks like addiction.

Key facts:

• A single low-dose intravenous ketamine treatment often reduces depressive symptoms within one day.
• The antidepressant effects from one ketamine infusion usually last about three to seven days.
• Esketamine is a nasal spray form of ketamine that the U.S. approved in 2019 as an add-on treatment for adults with depression that did not respond to other therapies.
• Esketamine is supplied under a safety program that requires it to be given while a person is monitored by medical staff.
• Short-term side effects at antidepressant doses include feeling disconnected from yourself, higher blood pressure, and confusion or agitation, and these side effects tend to occur around the time of the treatment.
• There is limited evidence about ketamine’s longer-term effects, so risks such as increased chance of misuse or dependence are not well known.
• Researchers are studying repeat-dose schedules and combining ketamine with other therapies to try to extend how long the benefits last.
• Studying ketamine may change how scientists understand mood disorders and could help lead to new kinds of treatments.

Abstract

-enantiomer, intranasal esketamine, for the treatment of major depressive disorder (MDD). Initial studies found that a single subanesthetic-dose IV ketamine infusion rapidly (within one day) improved depressive symptoms in individuals with MDD and bipolar depression, with antidepressant effects lasting three to seven days. In 2019, esketamine received FDA approval as an adjunctive treatment for treatment-resistant depression (TRD) in adults. Esketamine was approved under a risk evaluation and mitigation strategy (REMS) that requires administration under medical supervision. Both ketamine and esketamine are currently viable treatment options for TRD that offer the possibility of rapid symptom improvement. The manuscript also reviews ketamine's use in other psychiatric diagnoses-including suicidality, obsessive-compulsive disorder, post-traumatic stress disorder, substance abuse, and social anxiety disorder-and its potential adverse effects. Despite limited data, side effects for antidepressant-dose ketamine-including dissociative symptoms, hypertension, and confusion/agitation-appear to be tolerable and limited to around the time of treatment. Relatively little is known about ketamine's longer-term effects, including increased risks of abuse and/or dependence. Attempts to prolong ketamine's effects with combined therapy or a repeat-dose strategy are also reviewed, as are current guidelines for its clinical use. In addition to presenting a novel and valuable treatment option, studying ketamine also has the potential to transform our understanding of the mechanisms underlying mood disorders and the development of novel therapeutics.

Topics

Diet and metabolism studies Treatment of Major Depression Tryptophan and brain disorders

Categories

Health Sciences Medicine Pharmacology

Tags

Depression (economics) Economics Ketamine Macroeconomics Medicine Psychiatry Psychology Psychotherapist

Substances

Ketamine

Conditions & symptoms

Addiction Anxiety Depression Obsessive-Compulsive Disorder PTSD Substance abuse disorder Addiction or harmful habbits Lack of energy or motivation Sadness or low mood