[Ketamine in antidepressant treatment: a revolution?].
Biologie aujourd'hui 2023 DOI: 10.1051/jbio/2023023 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Randomized Peer reviewed |
|---|---|
| Interventions | Ketamine Esketamine |
| Topics | Depression Ketamine Esketamine |
| Keywords | Algorithme de traitement Dissociation Dépression résistante Kétamine Meta-analysis Méta-analyse Optimism bias Treatment resistant depression |
| Key findings | The authors report that ketamine has rapid antidepressant effects in treatment-resistant depression, supported by meta-analyses, with effect peaking at 24 hours. They propose that restoring optimism bias and belief-updating asymmetry mediates this effect, and that dissociation may contribute to the antidepressant action, while noting unresolved long-term safety and abuse concerns. |
Abstract
Thirty percent of depressed patients are treatment resistant (TRD) suggesting the need of new therapeutic strategy. Recently, it has been shown that ketamine, an anesthetic agent with dissociative effects, has potent and rapid antidepressant properties. Ketamine is a ionotropic glutamatergic NMDA antagonist that inhibits gabaergic neurons. Its antidepressant effect peaks at 24 h post-treatment. Several meta-analyses of placebo randomized clinical trials emphasized its efficacy. More recently, a meta-analysis showed its efficiency in real-world population of TRD patients. Although there is no clear biological or clinical predictors of response or remission to ketamine, patients with high level of resistance were found to remit less often. Restoring both the optimism bias and the asymmetry in belief updating mediates the antidepressant ketamine's effect. Consistent with predictive bayesian model and terror management theory, this suggests that dissociation induced by ketamine may contribute to its clinical antidepressant action. Although increasing access to ketamine and esketamine is welcome, legitimate concerns have been raised with respect to long-term safety and abuse risk.