ketamine in depression
Last edited 07/2023 and last reviewed 07/2023
Ketamine in depression
Ketamine is noncompetitive voltage-dependent N-methyl-D-aspartate receptor channel blocker whose antidepressant action is evident at low doses, and with increasing doses, it mimics psychotomimetic action and eventually leads to anesthesia in higher doses (1)
- single dose of ketamine has rapid action on depressive symptoms, and this action persists even for a week, which suggests its possible role in neuroplasticity
- ketamine may provide a rapid, robust, but transient antidepressant effect in MDD (major depressive disorder) and BD (bipolar depression)
- benefits of ketamine are transient, up to 1-2 weeks after infusion (2)
- benefits of ketamine are transient, up to 1-2 weeks after infusion (2)
- most common physical adverse effects of ketamine are dizziness, blurred vision, headache, nausea or vomiting, dry mouth, poor coordination, poor concentration and restlessness (3)
- effects have mostly been restricted to the time of administration, usually resolving within 60 minutes
- effects have mostly been restricted to the time of administration, usually resolving within 60 minutes
- the Royal College of Psychiatrists have stated (3)
- there is limited evidence to recommend ketamine as a viable treatment option for treatment resistant depression
- a systematic review found non-significant trend for ECT superiority over ketamine for post-treatment depression ratings (4)
- short term efficacy has been demonstrated after a single treatment, but benefits are not lasting for most patients, and mood can rapidly decline after initial improvement, potentially increasing suicide risk
- there is limited evidence to recommend ketamine as a viable treatment option for treatment resistant depression
- repeated subcutaneous ketamine injections for treatment-resistant depression (TRD)
- the authors of the KADS study concluded that:
- adequately dosed subcutaneous racemic ketamine was efficacious and safe in treating TRD over a 4-week treatment period
- the authors of the KADS study concluded that:
Reference:
- Mandal S, Sinha VK, Goyal N. Efficacy of ketamine therapy in the treatment of depression. Indian J Psychiatry. 2019 Sep-Oct;61(5):480-485.
- Corriger A, Pickering G. Ketamine and depression: a narrative review. Drug Des Devel Ther. 2019 Aug 27;13:3051-3067.
- Royal College of Psychiatrists (February 2017). Statement on ketamine to treat depression
- Menon V, Varadharajan N, Faheem A, Andrade C. Ketamine vs Electroconvulsive Therapy for Major Depressive Episode: A Systematic Review and Meta-analysis. JAMA Psychiatry. Published online April 12, 2023. doi:10.1001/jamapsychiatry.2023.0562
- Loo, C et al (2023). Efficacy and safety of a 4-week course of repeated subcutaneous ketamine injections for treatment-resistant depression (KADS study): Randomised double-blind active-controlled trial. The British Journal of Psychiatry, 1-9. doi:10.1192/bjp.2023.79