Ketamine and esketamine, which act on glutamatergic pathways, offer alternative therapeutic approaches for treatment-resistant depression (TRD) when conventional antidepressants fail. Ketamine is typically given intravenously in monitored settings, while esketamine is administered as an intranasal formulation under supervision. This narrative review outlines their proposed mechanisms, clinical uses, administration methods, and safety profiles. Tolerability and monitoring requirements are important considerations. These agents represent a developing area in TRD treatment and highlight the broader emergence of interventional psychiatry. Further research is needed to characterize long-term outcomes, refine protocols, and improve patient selection.
Sleep paralysis is a state during falling asleep or waking up in which a person is conscious but unable to move due to muscle atonia. It is often accompanied by three types of hallucinations: the intruder, the incubus, and out-of-body experiences, which can cause intense fear and distress. Sleep paralysis co-occurs with chronic conditions such as hypertension and obstructive sleep apnea, and is associated with post-traumatic stress disorder. Folklore has depicted the phenomenon for centuries, creating superstitions. Primary care physicians should empathetically address patient concerns, dispel myths scientifically, and consider asking about sleep paralysis episodes during routine interviews to liaise with specialists when needed.