Ketamine and Esketamine: Foundations, Patient Selection, and Algorithm Placement
April 21, 2026 DOI: 10.64239/pi-ec09801 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review |
|---|---|
| Interventions | Ketamine Esketamine |
| Topics | Esketamine Ketamine |
| Key findings | Ketamine and esketamine are appropriate only after multiple antidepressant failures, not for mild cases, and should be avoided in active or recent substance use disorder. |
Abstract
Reserve ketamine or esketamine for patients who have failed two to four adequate antidepressant trials. Weigh severity too; mild cases may not warrant it. Consider esketamine for acute suicidality in TRD despite the negative trial results. Placebo groups received excellent inpatient standard of care and improved substantially, masking the drug's benefit. Avoid ketamine and esketamine in active substance use disorder. Hesitate even in early recovery. Reconsider only after years of sustained remission.