Ketamine and Esketamine in Neurology and Psychiatry: An Overview.
Amalesh S Honnekeri
Cureus May 1, 2026 DOI: 10.7759/cureus.108571 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Narrative review Peer reviewed |
|---|---|
| Interventions | Ketamine Esketamine |
| Topics | Depression Esketamine Ketamine |
| Keywords | Interventional psychiatry Neuropsychiatry |
| Key findings | Ketamine and esketamine provide alternative therapeutic options for treatment-resistant depression, but further research is needed to refine protocols and patient selection. |
Abstract
Treatment-resistant depression (TRD) remains a significant clinical concern, particularly in patients who do not achieve adequate response with conventional antidepressant therapies. Ketamine and esketamine, which act on glutamatergic pathways, have been introduced into clinical practice as alternative therapeutic approaches within interventional psychiatry. This narrative review outlines key aspects of ketamine and esketamine use in psychiatric settings, including proposed mechanisms of action, clinical use cases, methods of administration, safety profiles, and areas of ongoing discussion. Ketamine is generally administered intravenously in monitored clinical settings, while esketamine is available as an intranasal formulation used under supervision. Considerations related to tolerability and monitoring requirements are relevant in clinical use. Ketamine and esketamine represent a developing area in the treatment of TRD and highlight the broader emergence of interventional approaches in psychiatry. Additional research is warranted to further characterize long-term outcomes, refine treatment protocols, and better define patient selection criteria.
Comparable studies
Other narrative reviews on esketamine for depression, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| 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 | |
| Long-term safety of ketamine and esketamine in treatment of depression | 2022 | Review | |
| Ketamine, Esketamine, and Arketamine: Their Mechanisms of Action and Applications in the Treatment of Depression and Alleviation of Depressive Symptoms. | 2024 | Review | |
| Variations in BDNF and Their Role in the Neurotrophic Antidepressant Mechanisms of Ketamine and Esketamine: A Review. Patients with depression | 2024 | Narrative review | |
| The Possible Application of Ketamine in the Treatment of Depression in Alzheimer’s Disease | 2022 | Review |