Key considerations for the use of ketamine and esketamine for the treatment of depression: focusing on administration, safety, and tolerability
Expert Opinion on Drug Safety April 27, 2022 DOI: 10.1080/14740338.2022.2069749 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Narrative review Randomized Placebo-controlled Double-blind Peer reviewed |
|---|---|
| Interventions | Ketamine Esketamine R-ketamine |
| Topics | Depression Esketamine Ketamine |
| Key findings | The authors conclude that intravenous ketamine and intranasal esketamine are validated rapid-acting treatments for depression and suicidal ideation, but that repeated dosing generally provides only about two to three weeks of relief. They recommend further investigation into optimal dosing and frequency, strategies to prolong therapeutic effects, co-administration with somatic and neuromodulation treatments, R-ketamine as a possible future antidepressant, and long-term monitoring for adverse effects. |
Abstract
ABSTRACT Introduction Racemic ketamine, a derivative of phencyclidine, has been used as a dissociative anesthetic since 1970. In 2000, the first randomized controlled trial showed a rapid relief of depressive symptoms. Since then, intravenous ketamine and intranasal S-ketamine have been validated for the treatment of depression and suicidal ideation following dose-response and double-blind placebo-controlled clinical trials. In clinical practice, after dose titration and with repeated treatments, patients may experience approximately 2–3 weeks of symptomatic relief from depression. Areas covered Areas covered in this narrative review include mechanism of action, dosing, safety, and tolerability. Some attention is paid to the possibility of R-ketamine as a future antidepressant. Expert opinion We recommend further investigation into treatment dosing and frequency strategies as well as approaches that prolong the therapeutic effects. The current fixed dosing of esketamine for obese individuals may be insufficient. Additional investigation into co-administration with somatic and neuromodulation treatments needs investigation. Finally, continuing to monitor research subjects and patients long-term for the emergence of adverse effects on cognition or other organ systems is critical.