Abstract Purpose of the review Treatment-resistant depression (TRD) is a challenging condition characterized by minimal improvement despite two or more antidepressant trials. Ketamine-assisted psychotherapy (KAP) integrates the rapid antidepressant effects of ketamine with psychotherapy to enhance and sustain therapeutic outcomes. This systematic review evaluates the effectiveness of KAP in...
Intensive care medicineMay 5, 2025Ary Serpa Neto, Marcus Young, Jian Wen Chan et al.9 citations
Ketamine use is a potentially modifiable risk factor for hallucinations. We aimed to use target trial emulation to investigate the association between low-dose ketamine and development of hallucinations in critically ill patients in the intensive care unit (ICU). Retrospective study using data from a university affiliated ICU in Melbourne, Australia. Application of marginal structural models...
Ketamine has anesthetic, analgesic, and antidepressant properties which may involve multiple neuromodulatory systems. In humans, the opioid receptor (OR) antagonist naltrexone blocks the antidepressant effect of ketamine. This mechanism may differentiate ketamine from other NMDA receptor antagonists. Animal models that reflect OR-dependent behavioral effects of ketamine may shed light on the...
Recent studies in mouse models have demonstrated that ketamine and rapastinel induce rapid-acting and sustained antidepressant effects in major depressive disorder (MDD). However, it remains unclear how ketamine's and rapastinel's opposing mechanisms of action-NMDAR antagonist and NMDAR positive allosteric modulator, respectively-result in similar antidepressant-like effects. Furthermore,...
Pharmacological management of major depressive disorder has traditionally relied on antidepressants targeting the monoaminergic pathway. Treatment-resistant depression (TRD) patients have been frequently excluded from registrational trials, resulting in a lack of clear clinical recommendations for an optimised management. In recent years, treatments based on other mechanisms of action have been...
MedicineMay 2, 2025Xiaobo Bi, Junchao Dai, Jin Li8 citations
This study aimed to investigate the effects of a single intravenous injection of esketamine during general anesthesia on postoperative anxiety and depression in patients with thyroid cancer. In this randomized, double-blind, placebo-controlled, parallel-group trial, eighty female patients with thyroid cancer were scheduled to undergo surgery under general anesthesia. The patients were randomly...
Ketamine has garnered attention for its rapid efficacy in alleviating depressive symptoms in treatment-resistant depression, offering a novel mechanism as a non-monoaminergic agent. Despite its potential, limited research has explored mental health professionals' perspectives on its use. This study assesses the attitudes, knowledge, and concerns of Portuguese psychiatrists and psychologists...
SUMMARYThis critical appraisal of a Cochrane Review assesses the efficacy of ketamine for treating unipolar major depressive disorder. The review included 31 randomised controlled trials involving ketamine. Results indicate that intravenous (i.v.) ketamine significantly improves antidepressant response compared with i.v. saline and, to a lesser extent, i.v. midazolam within 24–72 h. However,...
Cephalalgia ReportsMay 1, 2025Jonathan A. Leighton, Chieh Grace Lau, Aisha Savdo et al.2 citations
Background Cluster headache is an excruciating condition for which standard treatments are usually insufficient. Evidence has accumulated that serotonergic psychedelic indoleamines including psilocybin and LSD can be effective in preventing attacks. Methods In this case series, nine patients with episodic and chronic cluster headache that didn’t respond to conventional treatments were treated...
CureusMay 1, 2025Hafiza Wajeeha Waheed, Muhammad R Ashraf, Talha Sajjad et al.
Ketamine has been utilized in various medical contexts, particularly for its effects on the nervous system. Over time, its applications have expanded beyond its initial use, with emerging interest in its potential to influence mood and cognition. In certain clinical populations, it has been associated with a rapid reduction in depressive symptoms and suicidal thoughts, particularly when...
We previously reported that a single injection of (R,S)-ketamine or its metabolite (2S,6S)-hydroxynorketamine (HNK) prior to stress attenuated learned fear. However, whether these drugs attenuate learned fear through divergent or convergent effects on neural activity remains to be determined. 129S6/SvEv male mice were injected with saline, (R,S)-ketamine, or (2S,6S)-HNK 1 week before a 3-shock...
Acute behavioral disturbance is characterized by altered mental status and psychomotor agitation. Pharmacological sedation may be required, risking potential respiratory compromise. We compared the need for emergent airway support following administration of midazolam or ketamine to treat acute behavioral disturbance in the out-of-hospital setting. In this retrospective cohort study of patients...
Ketamine's use in treating bipolar depression must account for risks, such as switching to manic episodes or worsening symptoms. This study examines ketamine's impact on depressive symptoms, focusing on 'inner tension,' 'sleep reduction,' and 'suicidal ideation' over four weeks in treatment-resistant bipolar disorder (TR-BD) patients. Fifty-nine patients with TR-BD were treated consecutively...
Depression is a common and serious psychiatric disorder with significant impacts on individuals. Modified electroconvulsive therapy (MECT) is an established treatment for severe and treatment-resistant depression, but its cognitive side effects, particularly memory impairments, limit its use. Esketamine (ESK), an FDA-approved antidepressant, has shown neuroprotective effects. However, its role...
Ketamine, a dissociative anaesthetic, has expanded its clinical use beyond anaesthesia to pain management and treatment-resistant depression. As an N-methyl-d-aspartate receptor antagonist, ketamine disrupts the excitatory neurotransmission via interaction with the opioid, alpha-amino-3-hydroxy-5-methyl-4-isooxazole-propionic acid receptor and serotonin pathways, contributing to its broad...
Abnormalities during rapid eye movement (REM) sleep contribute to the pathophysiology of major depressive disorder (MDD), but few studies have explored the relationship between REM sleep and treatment-resistant depression (TRD). In MDD, REM sleep abnormalities often manifest as alterations in total night REM Density (RD), RD in the first REM period (RD1), and REM Latency (RL). Among these, RD1...
The drug development process in psychiatry faces significant challenges due to low reproducibility rates in animal testing, which often leads to translation failures. To address this issue, we introduce a new approach in psychiatric drug development: a preclinical randomized controlled trial (preRCT). To demonstrate its potential utility, we conducted a multi-center preRCT using the alcohol...
Previous studies have shown patient preference can have large effects on treatment adherence and patient satisfaction. However, the direct effects of matching treatment with patient preference on efficacy and safety outcomes remain unclear. We aimed to evaluate the effects of patient preference and preference-matching on efficacy, adverse events, and adherence to electroconvulsive therapy (ECT)...
Journal of Forensic SciencesMay 1, 2025Diane M Moore, Alexander D Giachetti, M Elizabeth Zaney et al.3 citations
Eight fatalities between September 2020 and July 2024 in Miami-Dade County involving the ingestion of colored powders, referred to as "tusi," "tucibi," or "pink cocaine," are reported. For each case, a description of the terminal event, the postmortem toxicology findings, the cause and manner of death, and the chemical composition of the "tusi" powder(s) found on or near the decedent are...
The pharmacologically active (R,S)-ketamine (ketamine) metabolite (2 R,6 R)-hydroxynorketamine (HNK) maintains ketamine's preclinical antidepressant profile without adverse effects. While hypotheses have been proposed to explain how ketamine and its metabolites initiate their antidepressant-relevant effects, it remains unclear how sustained therapeutic actions arise following drug elimination....