The Role of Ketamine in Treatment-resistant Depression: A Narrative Review

Summary & key facts

This paper is a narrative review about using ketamine for people whose depression did not get better with usual treatments. The authors looked at how ketamine works in the brain, the clinical studies that tested it, and its safety. They report that repeated ketamine treatments can relieve depressive symptoms quickly and often strongly, but there are real worries about side effects like feeling detached, changes in blood pressure or heart function, and the possibility of misuse. The review says we still need more research on long-term safety, who is most likely to benefit, and safer drugs that work in the same way.

Key facts:

• The authors reviewed many studies about ketamine as a treatment for depression that did not respond to usual medications.
• Repeated ketamine treatments tend to produce rapid and often strong antidepressant effects for people with treatment-resistant depression.
• Ketamine works by blocking a specific brain receptor called the NMDA receptor, which changes how brain cells communicate and may help relieve depression.
• Common safety concerns listed include dissociative symptoms, which means feeling detached or disconnected from yourself or the world.
• Other safety concerns include changes in blood pressure and heart function during treatment.
• There is a documented risk that ketamine could be misused or abused, especially with long-term therapy.
• The review highlights that long-term effects of repeated ketamine use are not well known and need more research.
• Researchers call for studies to find biological markers that predict who will respond to ketamine and for development of drugs that have similar benefits but fewer side effects or abuse potential.

Abstract

Ketamine, a non-competitive N-methyl-D-aspartate receptor antagonist, has emerged as an effective therapeutic agent for the management of treatment-resistant depression. Repeated treatments with ketamine show rapid, robust, and sustained antidepressant effects. Despite the large body of evidence, key concerns include adverse effects such as dissociative symptoms, hemodynamic instability, and the risk of abuse with long-term ketamine therapy. This narrative review provides an overview of the neurobiological mechanisms underlying ketamine’s antidepressant effects, its basic pharmacodynamics, and its safety profile. The clinical evidence regarding ketamine’s efficacy in depression is also summarized, and the need for further research on the long-term effects of ketamine therapy, the development of agents with similar antidepressant effects but fewer adverse effects or potential for abuse, and the identification of biomarkers to predict the response to ketamine is highlighted.

Topics

Stress Responses and Cortisol Treatment of Major Depression Tryptophan and brain disorders

Categories

Health Sciences Medicine Pharmacology

Tags

Art Depression (economics) Economics Ketamine Keynesian economics Literature Major depressive disorder Mood Narrative Narrative review Psychiatry Psychoanalysis Psychology Psychotherapist Treatment-resistant depression

Substances

Ketamine

Conditions & symptoms

Depression Addiction or harmful habbits Feeling disconnected from others Lack of energy or motivation Poor sleep Sadness or low mood