Ketamine treatment for depression: a review

Summary & key facts

This paper reviews studies of ketamine and its nasal form, esketamine, for treating hard-to-help depression and some other mental health problems. Early studies found that one low-dose intravenous ketamine infusion can reduce depressive symptoms within a day, with effects lasting about three to seven days. In 2019 a nasal esketamine spray was approved for adults with treatment-resistant depression and must be given under medical supervision. Short-term side effects such as feeling detached, high blood pressure, and confusion are common around the time of treatment. We still do not know much about long-term risks, including whether ketamine can lead to misuse. Researchers are testing repeat doses and combining ketamine with therapy to make benefits last longer.

Key facts:

• Researchers reviewed studies of ketamine and esketamine as treatments for depression and some other psychiatric conditions.
• One low-dose intravenous ketamine infusion often reduced depressive symptoms quickly, usually within one day.
• The antidepressant effects after a single infusion commonly lasted about three to seven days.
• In 2019, a nasal spray form called esketamine was approved for adults with treatment-resistant depression and must be given under medical supervision.
• Common short-term side effects at antidepressant doses include dissociative symptoms (feeling detached), increased blood pressure, and confusion or agitation, and these effects tend to occur around the time of treatment.
• There is limited information about longer-term effects, including whether regular use increases the risk of misuse or dependence.
• Researchers are trying repeat-dose schedules and combining ketamine with psychotherapy to extend its benefits.
• Studying ketamine may help scientists understand how mood disorders work and 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