Ketamine, Esketamine, and A New Generation of Antidepressants
Samuel T. Wilkinson, Brandon Kitay
Psychiatric Annals February 1, 2020 DOI: 10.3928/00485713-20200113-02 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Interventions | Esketamine Brexanolone AXS-05 SAGE-217 |
| Topics | Esketamine Ketamine |
| Key findings | The review reports that esketamine is approved for treatment-resistant depression and brexanolone for postpartum depression, both subject to FDA REMS requirements that pose challenges to clinical adoption; it also reviews late-stage compounds AXS-05 and SAGE-217. |
Abstract
Since the discovery of its rapid-acting antidepressant properties, ketamine has helped stimulate a new line of research in the development of rapid-acting antidepressants based on the glutamate and gamma-aminobutyric acid neurotransmitter systems. An intranasal version of the S-enantiomer of ketamine (esketamine) recently received regulatory approval as a therapy for treatment-resistant depression (TRD). Here we review the clinical evidence of esketamine for TRD, challenges to its adoption in clinical practice, and the regulatory requirements imposed by the US Food and Drug Administration (FDA) through a risk evaluation and mitigation strategy (REMS). Brexanolone, an exogenous formulation of allopregnanolone, also recently received FDA approval for the treatment of postpartum depression and is likewise subject to a REMS. Other compounds in late-stage development, including AXS-05 and SAGE-217, are also reviewed. [ Psychiatr Ann . 2020;50(2):54–61.]
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 15
- mTOR-Dependent Synapse Formation Underlies the Rapid Antidepressant Effects of NMDA Antagonists Science August 19, 2010
- NMDAR inhibition-independent antidepressant actions of ketamine metabolites Nature April 24, 2016
- Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment for Relapse Prevention in Patients With Treatment-Resistant Depression JAMA Psychiatry June 5, 2019
- The effect of a single dose of intravenous ketamine on suicidal ideation: a systematic review and individual participant data meta-analysis American Journal of Psychiatry October 3, 2017
- Efficacy and Safety of Intranasal Esketamine for the Rapid Reduction of Symptoms of Depression and Suicidality in Patients at Imminent Risk for Suicide: Results of a Double-Blind, Randomized, Placebo-Controlled Study American Journal of Psychiatry April 16, 2018
and 10 more in the library