Nutrients
November 20, 2021
Johanna Louise Keeler, Janet Treasure, Mario F Juruena et al.
55 citations
Anorexia nervosa is difficult to treat, especially in severe and enduring cases. Malnutrition and weight loss can reduce grey and white matter in the brain, impair neuroplasticity and neurogenesis, and cause difficulties with cognitive flexibility, memory, and learning. Depression is highly comorbid and may hinder recovery, but traditional antidepressants are often ineffective in underweight patients. This review presents a conceptual overview for treating anorexia nervosa with ketamine. Ketamine has rapid antidepressant effects hypothesized to occur via increased glutamate, leading to increased neuroplasticity, neurogenesis, and synaptogenesis. The article covers ketamine's use for common psychiatric comorbidities and discusses safety concerns. There appears ample theoretical background to warrant exploring ketamine as a treatment for adults with anorexia nervosa.
Brazilian Journal of Psychiatry
July 3, 2020
Simon Ruffell, Nige Netzband, Catherine Bird et al.
43 citations
Ayahuasca, a South American psychoactive plant brew used in traditional spiritual and cultural rituals, has been studied primarily for the prevention of deamination of N,N-dimethyltryptamine (DMT) by monoamine oxidase inhibitors (MAOIs) in the brew. Two constituents, DMT and harmine, have received more research attention than secondary harmala alkaloids. Current evidence suggests that the pharmacological interactions in ayahuasca may act synergistically or additively to produce psychoactive effects, but the understanding of these synergistic mechanisms is limited and more complex processes may be involved. There is not yet enough data to determine any potential synergistic interaction between the known compounds, and increased pharmacological understanding is needed to avoid potential risks.
Journal of psychopharmacology (Oxford, England)
January 1, 2025
Gianmarco Ingrosso, Anthony J. Cleare, Mario F Juruena
20 citations
A review of 16 studies involving 2,174 patients found that addiction phenomena during ketamine treatment for depression are rare. Only four patients showed clear signs of tolerance or dependence, while the vast majority did not. The review included randomized controlled trials and other study designs using various routes of administration, including intravenous and intranasal esketamine. The findings suggest that medically supervised ketamine treatment is relatively safe for adult depression patients, though the authors emphasize the need for vigilant monitoring and careful dosing. Future research using standardized scales could further strengthen evidence for safe use.
BMC Psychiatry
January 2, 2024
Minna Chang, Mario F Juruena, Allan H. Young
16 citations
Ketamine, a promising antidepressant for treatment-resistant depression, can cause ulcerative cystitis—a bladder condition with lower urinary tract symptoms and potential kidney damage seen in over 25% of regular recreational users. This condition, known as ketamine-induced cystitis (KIC), had not been reported in therapeutic use until now. A 28-year-old woman developed KIC symptoms after starting ketamine for depression, confirmed by urine tests. Early diagnosis and stopping ketamine can improve symptoms and prevent further harm. This is the first reported case of KIC in a patient receiving treatment-dose ketamine for depression.
Neuropsychiatric Disease and Treatment
January 1, 2023
Allan H. Young, Mohamed Abdelghani, Mario F Juruena et al.
10 citations
Treatment-resistant depression (TRD) imposes severe burdens on patients, health services, and society, yet has lacked viable treatment options. An advisory panel of psychiatrists and clinical researchers experienced in managing TRD developed best practice statements on using esketamine nasal spray, one of the first TRD treatments licensed in 30 years. The panel agreed on recommendations for setting up and running an efficient esketamine clinic, emphasizing logistical planning, patient education to prevent discontinuation, and checklists for safe appointments. Expanding treatment options like esketamine nasal spray is likely key to improving long-term outcomes for this underserved population.
Journal of psychopharmacology (Oxford, England)
June 20, 2025
Mutahira Qureshi, Daniel Silman, Romayne Gadelrab et al.
3 citations
A single dose of immediate-release oral ketamine (40–240 mg) was safe and generally well-tolerated in healthy adults, with no unexpected safety signals or discontinuations due to side effects. Eighty mild or moderate treatment-emergent adverse events occurred after ketamine doses, most commonly dissociation, dizziness, and headache, while only five occurred after placebo. Dissociation events increased with higher doses. Ketamine and its metabolites showed dose-proportional pharmacokinetics. Transient mood and dissociation changes appeared one hour after dosing and resolved within about four hours. These results support further investigation of oral ketamine capsules for treatment-resistant depression.
Psychopharmacology
February 7, 2026
Rebecca J Simpson, Mario F Juruena
1 citation
Ketamine-assisted psychotherapy (KAP) shows promise for treatment-resistant depression, with reductions in depressive symptoms sustained up to six months in some cases. However, among the three studies with control groups, no significant differences were found between KAP and control conditions. Methodological heterogeneity across the 11 included studies—including variability in treatment protocols, outcome measures, and study designs—limits the ability to draw firm conclusions or identify mechanisms driving KAP's effects. More rigorous research, particularly randomized controlled trials, is needed to better understand its efficacy and mechanisms.
Translational Psychiatry
May 12, 2026
Linda Bryant, Laith Alexander, Sergio Mena et al.
A machine-learning model using structural brain scans predicted which adults with treatment-resistant depression would respond to a single ketamine infusion. The model, trained on 99 participants, achieved 72% balanced accuracy in the discovery sample and 60% in two independent groups, with performance dropping to chance in a saline-treated control group. Greater gray matter volume in frontal regions predicted response, while greater cerebellar volume predicted non-response. The findings suggest that pre-treatment brain structure may help guide personalized treatment decisions for ketamine therapy.
Journal of psychopharmacology (Oxford, England)
April 16, 2026
Minna Chang, Allan H. Young, Mario F Juruena
Both electroconvulsive therapy (ECT) and ketamine show sustained therapeutic potential for treatment-resistant depression, with ECT possibly associated with longer remission. Higher doses, more frequent administration, and maintenance ECT or ketamine appear to prolong remission, and continuing oral antidepressants may extend it further. This systematic review of 13 studies found no direct head-to-head comparisons of time-to-relapse between the two treatments that met inclusion criteria, preventing formal statistical analysis. The review excluded studies involving psychotic depression, limiting generalizability to those populations.
BJPsych Open
June 1, 2025
Minna Chang, Allan H. Young, Mario F Juruena
A 28-year-old woman receiving ketamine for depression developed ulcerative cystitis, a complication previously seen only in recreational users. Ketamine-induced cystitis (KIC) causes lower urinary tract symptoms—dysuria, urgency, nocturia, frequency—and can progress to incontinence, hematuria, bladder fibrosis, and kidney damage. The exact cause is unknown, but theories include direct toxicity from ketamine metabolites, an IgE-mediated allergic response, and other inflammatory pathways. Early diagnosis and stopping ketamine can reverse symptoms and prevent further harm. This is the first reported case of KIC from therapeutic-dose ketamine for depression.