Use of Ketamine and Esketamine in the Pediatric Population: Current Evidence and Clinical Applications.
Thomas Kun Pak, Stephen Kimatian, Graham J Emslie, Emine Rabia Ayvaci
FOCUS: The Journal of Lifelong Learning in Psychiatry April 1, 2026 DOI: 10.1176/appi.focus.20250040 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Population | Adult and pediatric populations |
| Topics | Esketamine Ketamine |
| Keywords | Child/adolescent psychiatry Pharmacokinetics/pharmacodynamics |
| Key findings | Ketamine and esketamine have diverse therapeutic applications, but their use in pediatric populations is complicated by developmental stage, pharmacokinetics, and neurodevelopmental factors. |
Abstract
Ketamine is a well-established anesthetic agent that is gaining increasing recognition for its diverse therapeutic applications, including the management of chronic pain, refractory status epilepticus, major depressive disorder, and suicidality. Although it has been used clinically since the 1960s, multiple clinical trials with ketamine and esketamine in adults and pediatric populations are ongoing. There has been recent growing interest in ketamine and esketamine for psychiatric conditions in children and adolescents. The clinical use of ketamine is complex, in part because of the numerous available formulations and administration routes. Ketamine has different bioavailability depending on the route of administration: intravenous (100%), intramuscular (64%-93% in adults, 41% in pediatric populations), intranasal (43%-48% in adults, 50% in pediatric populations), sublingual (29%-32%), rectal (25%-30%), epidural (77%), and oral (17%-18%), which is due to extensive first-pass hepatic metabolism. Differences in dosing also produce distinct clinical effects. The challenges associated with ketamine use are further magnified in pediatric populations, for which developmental stage, pharmacokinetics, and neurodevelopmental factors play critical roles in guiding safe and effective treatment. In this review, the authors summarize the pharmacodynamics, pharmacokinetics, adverse effects and contraindications, and clinical applications of ketamine and esketamine among adult and pediatric populations.
Comparable studies
Other narrative reviews on esketamine, 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 | |
| The potential of ketamine for posttraumatic stress disorder: a review of clinical evidence. | 2023 | Review | |
| Variations in BDNF and Their Role in the Neurotrophic Antidepressant Mechanisms of Ketamine and Esketamine: A Review. Patients with depression | 2024 | Narrative review |
Citations in the library
Cites 33
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- Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms Pharmacological Reviews June 26, 2018
- Mechanisms of Ketamine Action as an Antidepressant Molecular Psychiatry March 13, 2018
- Taming the Ketamine Tiger Anesthesiology August 6, 2010
- Attenuation of Antidepressant Effects of Ketamine by Opioid Receptor Antagonism American Journal of Psychiatry August 29, 2018
and 28 more in the library