The FDA has approved S-ketamine nasal spray for treatment-resistant depression, marking a new class of psychiatric drugs. This approval comes 30 years after psychedelics were first studied for mental health treatment. Intravenous ketamine infusion has been researched for depression since the 1990s. The article describes the current protocol for ketamine infusion therapy in patients with treatment-resistant depression and provides related clinical information.
Treatment-resistant depression (TRD) requires effective mood-elevating interventions. Ketamine and its S-enantiomer esketamine have shown effectiveness in TRD through successful clinical trials. In 2019, the FDA approved intranasal esketamine for TRD, although intravenous ketamine is more effective. Esketamine treatment carries major adverse effects including psychosis risk, abuse and dependence potential with repeated use, transient changes in blood pressure and heart rate, and toxicity to the urothelium and liver. These risks are minimized when dosing is within the recommended range and administration is by experienced personnel. The benefits of esketamine appear to offset these risks across depressive symptoms like anhedonia, anxiety, cognitive impairment, suicidality, and dysfunction. The review calls for more phase 4 studies evaluating real-life long-term effectiveness and risks.