Ketamine Quickly Eases Depression, But Questions Remain
The anesthetic agent ketamine and other glutamatergic drugs produce rapid antidepressant effects in humans, reports a new evidence review published online in the Harvard Review of Psychiatry. However, questions about the agents and their ramifications persist.
“This paradigm shift lends additional urgency to the development of novel treatments for major depressive disorder and bipolar depression, particularly for patient subgroups that do not respond to currently available therapies,” wrote Carlos A. Zarate Jr., MD, and colleagues at the National Institute of Mental Health.
In their review, Dr. Zarate and colleagues reported that ketamine has demonstrated antidepressant response in patients with treatment-resistant major depressive disorder within 2 hours of intravenous injection. Peak effects in the population occurred at 24 hours.
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Evidence suggests ketamine may also ease suicidal thoughts, according to the review. In people with treatment-resistant bipolar depression, ketamine combined with other medications has demonstrated quick antidepressant effect.
Consequently, some providers are already using ketamine for severe or treatment-resistant depression, the authors pointed out. However, such use is off-label, unstandardized, and unregulated, and questions about the drug’s side effects and abuse potential remain.
“Efforts are underway,” they added “to bring ketamine to market, standardize its use, and determine its real-world effectiveness.”
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Esketamine, another glutamatergic medication, has received breakthrough status from the US Food and Drug Administration for patients at imminent risk of suicide, they noted.
In another review, also published online in the Harvard Review of Psychiatry, a study team evaluated neuroimaging research on ketamine’s effects on brain areas involved in depression.
Ketamine may “acutely disable the emotional resources required to perpetuate the symptoms of depression,” reported Cristina Cusin, MD, of Massachusetts General Hospital in Boston, and colleagues. The drug may also increase emotional blunting as well as boost activity in reward processing, they wrote.
—Jolynn Tumolo
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