Ketamine-Associated Brain Changes: A Review of the Neuroimaging Literature
Dawn F. Ionescu, J. Felicione, Aishwarya K. Gosai, Cristina Cusin, Philip Shin, Benjamin G. Shapero, Thilo Deckersbach
Harvard Review of Psychiatry February 20, 2018 DOI: 10.1097/hrp.0000000000000179 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Intervention | Ketamine |
| Dose | Subanesthetic doses |
| Topics | Esketamine Ketamine |
| Key findings | The authors report that neuroimaging studies of ketamine in treatment-resistant depression repeatedly implicate the subgenual anterior cingulate cortex and suggest ketamine may decrease self-monitoring, increase emotional blunting, and increase reward-processing activity. They conclude that ketamine's antidepressant mechanism remains incompletely understood and requires further study. |
Abstract
Abstract Major depressive disorder (MDD) is one of the most prevalent conditions in psychiatry. Patients who do not respond to traditional monoaminergic antidepressant treatments have an especially difficult-to-treat type of MDD termed treatment-resistant depression. Subanesthetic doses of ketamine—a glutamatergic modulator—have shown great promise for rapidly treating patients with the most severe forms of depression. As such, ketamine represents a promising probe for understanding the pathophysiology of depression and treatment response. Through neuroimaging, ketamine’s mechanism may be elucidated in humans. Here, we review 47 articles of ketamine’s effects as revealed by neuroimaging studies. Some important brain areas emerge, especially the subgenual anterior cingulate cortex. Furthermore, ketamine may decrease the ability to self-monitor, may increase emotional blunting, and may increase activity in reward processing. Further studies are needed, however, to elucidate ketamine’s mechanism of antidepressant action.
Comparable studies
Other narrative reviews on ketamine, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms | 2018 | Review | |
| Mechanisms of Ketamine Action as an Antidepressant | 2018 | Review | |
| 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 | |
| Ketamine Pharmacology: An Update (Pharmacodynamics and Molecular Aspects, Recent Findings) | 2013 | Review | |
| A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders | 2017 | Review and consensus statement |
Citations in the library
Cited by 47
- Ketamine as an antidepressant: overview of its mechanisms of action and potential predictive biomarkers Therapeutic Advances in Psychopharmacology 2020
- A Dendrite-Focused Framework for Understanding the Actions of Ketamine and Psychedelics Trends in Neurosciences December 21, 2020
- Ketamine exerts its sustained antidepressant effects via cell-type-specific regulation of Kcnq2. Neuron May 1, 2022
- An Integrative Approach to Ketamine Therapy May Enhance Multiple Dimensions of Efficacy: Improving Therapeutic Outcomes With Treatment Resistant Depression. Frontiers in Psychiatry November 24, 2021
- Pharmacodynamic Interactions Between Ketamine and Psychiatric Medications Used in the Treatment of Depression: A Systematic Review The International Journal of Neuropsychopharmacology June 25, 2021
and 42 more in the library
Cites 36
- A Randomized Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Major Depression Archives of General Psychiatry August 1, 2006
- mTOR-Dependent Synapse Formation Underlies the Rapid Antidepressant Effects of NMDA Antagonists Science August 19, 2010
- Synaptic Dysfunction in Depression: Potential Therapeutic Targets Science October 4, 2012
- Ketamine Anesthesia & Analgesia November 1, 1998
- Ketamine activates psychosis and alters limbic blood flow in schizophrenia Neuroreport April 1, 1995
and 31 more in the library