Intravenous Ketamine in Psychiatry: Therapeutic Applications, Mechanisms of Action, and Clinical Perspectives
Juliana Leite Haubman, João Octávio Celante da Silva, Bruno Horta Leonardo Machado de Moura, Paula de Vasconcellos Vargas, Alice Ruiz Garcia, Maria Eduarda Galles Cunha Zambrin, Maria Luiza Kummer, Giovanna Montiel Scherer, Talissa Nadiane Bugs, Helenna Vieira Schvartz
Open Minds International Journal July 6, 2026 DOI: 10.22533/at.ed.51572142603075 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Narrative literature review Peer reviewed |
|---|---|
| Intervention | Intravenous esketamine |
| Topics | Ketamine Esketamine |
| Keywords | Medline Action physics Drug Clinical trial Anesthesia Intensive care medicine |
| Key findings | Intravenous esketamine produces a rapid antidepressant response in patients with treatment-resistant depression and shows benefits for anxiety disorders, bipolar disorder, and suicide prevention. |
Abstract
Intravenous esketamine represents a significant therapeutic innovation in the field of psychiatry, particularly in the management of treatment-resistant depression and severe psychiatric conditions associated with suicidal ideation.Derived from the S-enantiomer of ketamine, esketamine acts primarily as an N-methyl-D-aspartate (NMDA) receptor antagonist, promoting rapid glutamatergic modulation and brain neuroplasticity.The present study aims to review the scientific literature on the use of intravenous esketamine in psychiatry, addressing its mechanisms of action, clinical indications, therapeutic efficacy, adverse effects, and current challenges.This is a narrative literature review conducted through the analysis of scientific articles indexed in the PubMed, Scielo, MEDLINE, and Google Scholar databases, published between 2015 and 2026, in Portuguese and English.The findings demonstrate that intravenous ketamine produces a rapid antidepressant response, with significant improvement in symptoms among patients refractory to conventional treatments.Furthermore, studies show benefits in anxiety disorders, bipolar disorder, and suicide prevention.However, adverse effects such as dissociation, transient elevation of blood pressure, nausea, and abuse potential still represent significant limitations.It is concluded that intravenous ketamine is a promising and effective alternative in contemporary psychiatry, although further long-term studies are needed to establish safe and standardized protocols.
Comparable studies
Other narrative reviews on ketamine, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms | 2018 | Review | |
| Mechanisms of Ketamine Action as an Antidepressant | 2018 | Review | |
| Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation Adults with treatment-resistant depression | 2021 | Review | |
| Ketamine Pharmacology: An Update (Pharmacodynamics and Molecular Aspects, Recent Findings) | 2013 | Review | |
| A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders | 2017 | Review and consensus statement |