Depression is a common and long-lasting mental disorder with many interconnected biological pathways. Recent research has found that ketamine, a drug that blocks NMDA receptors, can produce rapid antidepressant effects, offering a new approach to treating mood disorders. This review summarizes current knowledge about signaling pathways and systems involved in depression, drawing from studies of patients and animal models. It focuses on how ketamine works as a fast-acting antidepressant and discusses its potential for preventing or treating stress-related psychiatric conditions.
Electroconvulsive therapy (ECT) is effective for treatment-resistant major depressive disorder. Combining esketamine with propofol anesthesia during ECT may improve outcomes. In a randomized, double-blind trial, 111 patients were assigned to receive propofol alone (1 mg/kg), low-dose esketamine (0.25 mg/kg) with propofol (0.75 mg/kg), or higher-dose esketamine (0.5 mg/kg) with propofol (0.5 mg/kg). Outcomes included depression scales, suicide risk, cognitive function, hospital stay, readmission, and side effects. The results may guide better ECT anesthesia choices.
Mindfulness training combined with usual care reduced anxiety and depression more than usual care alone in a randomized trial of 133 patients with anxiety or depression symptoms. After eight weeks, the mindfulness group scored lower on the Hamilton Anxiety Rating Scale (20.88 vs 25.95) and Hamilton Depression Rating Scale (21.24 vs 26.37) and higher on mindfulness and resilience measures. Psychological resilience partially mediated the improvements, accounting for about 10% of the anxiety reduction and 19% of the depression reduction. The results suggest mindfulness works both directly and by strengthening resilience, supporting its use as an add-on treatment.