April 21, 2026
Samuel T. Wilkinson
When a patient relapses after tapering off ketamine or esketamine, consider restarting an index course (twice weekly for a few weeks, then spread out). With ketamine or esketamine, dysphoric reactions occur in roughly 1 in 200-300 treatments. Many resolve with supportive care alone; others require a short-acting benzodiazepine such as lorazepam. For esketamine sessions, have patients fast for...
Current Pain and Headache Reports
April 21, 2026
Navy C Coggins, Hanson A Chokr, Tricia A Meyer et al.
PURPOSE OF REVIEW: Ketamine was originally developed as a dissociative anesthetic and has remained a valuable agent in anesthesia related to its ability to preserve airway reflexes and relative hemodynamic stability. Over time, its clinical applications have expanded beyond procedural sedation to include roles in pain management and psychiatry. In pain medicine, the therapeutic rationale is...
Translational Psychiatry
April 21, 2026
Paul A Parcon, Amanda Bardhoshi, Amanda Olsen-Dufour et al.
The N-methyl-D-aspartate (NMDA) receptor antagonist ketamine is a robust, rapid-acting antidepressant whose molecular effects have not been fully elucidated. Phosphodiesterase-4 (PDE4), which terminates cyclic adenosine monophosphate (cAMP) activity, may underlie antidepressant response. In particular, previous studies found that whole brain binding of the positron emission tomography (PET)...
Pain Management
April 16, 2026
Theresa R. Lii, Pilleriin Sikka, Ben Deverett et al.
INTRODUCTION Ketamine shows promise for treatment-refractory chronic pain and depression, but randomized trials risk unblinding from ketamine's acute dissociative effects. Propofol sedation may mitigate this, though it has not been prospectively tested as a masking strategy outside of surgical contexts. METHODS This protocol describes a single-center, randomized, double-blind,...
Journal of Psychopharmacology
April 16, 2026
Minna Chang, Allan H. Young, Mario F Juruena
Previous systematic reviews and meta-analyses have reported impressive antidepressant effects of ketamine in treatment-resistant depression (TRD). While ketamine has been compared with electroconvulsive therapy (ECT), the gold standard treatment, the extent and durability of its antidepressant effects over longer periods remain unclear. To our knowledge, this is the first systematic review...
Journal of Intensive Care Medicine
April 16, 2026
Vrutti Patel, Saurabh Sujanyal, Lekhya Raavi et al.
BackgroundKetamine has demonstrated efficacy in treatment-resistant depression, primarily in psychiatric or outpatient populations. Its use in ICU patients remains underexplored, with limited data beyond case reports and small series. This study evaluated the association between subanesthetic ketamine infusions and improvement in depressive symptoms and hemodynamic changes in ICU...
Pharmaceuticals
April 16, 2026
Maria Marmureanu, Mariana Valy Besoiu, Vlad Dionisie et al.
Background/Objective: A substantial proportion of patients with obsessive-compulsive disorder (OCD) does not respond adequately to first-line treatments such as selective serotonin reuptake inhibitors and cognitive-behavioral therapy. OCD has traditionally been conceptualized as a serotonergic disorder. However, emerging evidence suggests that glutamatergic dysfunction plays an important role....
Journal of Affective Disorders
April 15, 2026
Gia Han Le, Sabrina Wong, Danica E. Johnson et al.
4 citations
Ketamine and esketamine exhibit rapid antidepressant effects in persons with treatment-resistant depression (TRD) and bipolar depression (TRBD). However, the synaptic mechanisms governing dose, frequency, and durability of response remain unclear. This review aims to evaluate the dosing parameters, including minimum dose and optimal dosing intervals, that reliably induce or maintain long-term...
Molecular Psychiatry
April 13, 2026
Xin Zhao, Xinyu Zhang, Shiying Yuan et al.
Ketamine, a potent N-methyl-D-aspartate receptor (NMDAR) antagonist, is widely used for anesthesia and analgesia and, because of its rapid antidepressant effects, in psychiatry. Increasing evidence suggests that ketamine and its enantiomers-(R)-ketamine (arketamine) and (S)-ketamine (esketamine)-also modulate systemic immunity and provide organ protection, partly through interactions with the...
Translational Psychiatry
April 10, 2026
Ting-Hui Liu, Hong-Shiang Shen, Jheng-Yan Wu et al.
1 citation
This study aimed to evaluate the long-term effectiveness and safety of esketamine in adults with Major depressive disorder (MDD), focusing on suicide-related events, all-cause mortality, and major adverse cardiovascular events (MACEs). This target-trial simulation used the TriNetX Global Collaborative Network. Adults (≥ 18 years) with MDD who received either esketamine or a conventional...