Esketamine for Depression: From Therapeutic Characteristics to Efficacy and Safety
Ziteng Qiu
MedScien October 23, 2025 DOI: 10.61173/mxshjv72 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Intervention | Esketamine |
| Topics | Depression Esketamine Ketamine |
| Key findings | Esketamine rapidly relieves depressive symptoms and reduces suicidal ideation across multiple depression subtypes, offering a new treatment perspective where conventional therapies fall short. |
Abstract
More than 280 million individuals worldwide suffer from depression, which is one of the main causes of mental disability. It has multiple subtypes, and conventional treatments have limitations such as slow onset of action, high non-response rate, and numerous side effects. For instance, it takes two to six weeks for selective serotonin reuptake inhibitors (SSRIs) to start working, and about 30% of patients experience treatment resistance. These limitations make conventional treatments unable to meet clinical needs, especially failing to address the urgent intervention needs of patients at risk of suicide. As the S-enantiomer of ketamine, esketamine exhibits a stronger binding affinity for NMDA receptors compared to its counterpart (the R-enantiomer of ketamine, or racemic ketamine). It relieves depressive symptoms rapidly through a unique mechanism of action and can also reduce suicidal ideation. Esketamine has shown therapeutic potential in various subtypes of depression, including Major Depressive Disorder (MDD) with acute suicidal ideation or behavior, Postpartum Depression (PPD), Treatment-Resistant Depression (TRD), Bipolar Depression (BD), and Atypical Depression (AD). Moreover, the combination of esketamine with oral antidepressants can improve therapeutic efficacy. Future efforts should focus on evaluating its long-term safety and dependence risks, expanding its therapeutic indications, conducting research on special populations, and developing biomarkers for predicting treatment response. This paper reviews the development and characteristics of esketamine, as well as its therapeutic applications in different types of depression, providing a new perspective for depression treatment.
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 |