AdolescentsDepressive DisordersPTSDKetamine

Ketamine as a promising prototype for a new generation of rapid-acting antidepressants

This review (2015) summarizes the clinical effects of ketamine and its neurobiological underpinnings and mechanisms of action that may provide insight into the neurobiology of depression, relevant biomarkers, and treatment targets, and directions for future research.

Authors

  • John Krystal
  • Lauren Averill
  • Chadi Abdallah

Published

Annals of the New York Academy of Sciences
meta Study

Abstract

Review: The discovery of ketamine’s rapid and robust antidepressant effects opened a window into a new generation of antidepressants. Multiple controlled trials and open-label studies have demonstrated these effects across a variety of patient populations known to often achieve little to no response from traditional antidepressants. Ketamine has been generally well tolerated across patient groups, with transient mild to moderate adverse effects during infusion. However, the optimal dosing and route of administration and the safety of chronic treatment is not fully known. This review summarizes the clinical effects of ketamine and its neurobiological underpinnings and mechanisms of action that may provide insight into the neurobiology of depression, relevant biomarkers, and treatment targets. Moreover, we offer suggestions for future research that can continue to advance the field forward and ultimately improve the psychopharmacologic interventions available for those individuals struggling with depressive and trauma-related disorders.

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Research Summary of 'Ketamine as a promising prototype for a new generation of rapid-acting antidepressants'

Introduction

Abdallah and colleagues frame the problem by noting that depressive disorders remain a leading cause of disability worldwide and that, despite more than five decades of antidepressant development, available medications mostly target monoaminergic systems and produce limited and slow clinical benefit for many patients. Previous large-scale clinical work has shown that fewer than one-third of depressed patients achieve remission within 12 weeks on traditional antidepressant regimens, and a substantial minority remain refractory despite multiple medication trials. This context motivates the search for novel, rapid-acting treatments. The review sets out to synthesise clinical and mechanistic evidence about ketamine as a prototype for a new generation of rapid-acting antidepressants. Specifically, the authors summarise controlled and open-label clinical trials of ketamine for depression (including treatment-resistant groups), examine preliminary data in posttraumatic stress disorder (PTSD) and cognitive outcomes, outline proposed neurobiological mechanisms and candidate clinical biomarkers, and identify knowledge gaps and priorities for future research and clinical translation.

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Study Details

References (11)

Papers cited by this study that are also in Blossom

Antidepressant effects of ketamine in depressed patients

Berman, R. M., Cappiello, A., Anand, A. et al. · Biological Psychiatry (2000)

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Murrough, J. W., Iosifescu, D. V., Chang, L. C. et al. · American Journal of Psychiatry (2013)

Ketamine and Rapid-Acting Antidepressants: A Window into a New Neurobiology for Mood Disorder Therapeutics

Ari, A., Abdallah, C. G., Sanacora, G. et al. · Annual Review of Medicine (2014)

A Randomized Add-on Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Bipolar Depression

Diazgranados, N., Ibrahim, L., Brutsche, N. E. et al. · JAMA Psychiatry (2010)

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A single infusion of ketamine improves depression scores in patients with anxious bipolar depression

Ionescu, D. F., Luckenbaugh, D. A., Niciu, M. J. et al. · Bipolar Disorders (2014)

Improvement in suicidal ideation after ketamine infusion: Relationship to reductions in depression and anxiety

Ionescu, D. F., Vande Voort, J. L., Niciu, M. J. et al. · Journal of Psychiatric Research (2014)

Rapid and Longer-Term Antidepressant Effects of Repeated Ketamine Infusions in Treatment-Resistant Major Depression

Murrough, J. W., Perez, A. M., Pillemer, S. et al. · Biological Psychiatry (2012)

Ketamine as the prototype glutamatergic antidepressant: pharmacodynamic actions, and a systematic review and meta-analysis of efficacy

Caddy, C., Giaroli, G., White, T. P. et al. · Therapeutic Advances in Psychopharmacology (2013)

Single Ketamine Infusion and Neurocognitive Performance in Bipolar Depression

Permoda-Osip, A., Kisielewski, J., Bartkowska- Sniatkowska, A. et al. · Pharmacopsychiatry (2014)

Show all 11 references
Replication of Ketamine’s Antidepressant Efficacy in Bipolar Depression: A Randomized Controlled Add-On Trial

Zarate, C. A., Brutsche, N. E., Ibrahim, L. et al. · Biological Psychiatry (2012)

757 cited

Cited By (12)

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So how special is special K? A systematic review and meta-analysis of ketamine for PTSD RCTs

Borgogna, N. C., Owen, T., Vaughn, J. et al. · European Journal of Psychotraumatology (2024)

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Abdallah, C. G., Averill, L. A., Gueorguieva, R. et al. · Neuropsychopharmacology (2020)

High-dose ketamine infusion for the treatment of posttraumatic stress disorder in combat veterans.

Ross, C., Jain, R., Bonnett, C. J. et al. · American Academy of Clinical Psychiatrists (2019)

Repeated ketamine injections in synergy with antidepressants for treating refractory depression: A case showing 6-month improvement

Wang, L., Wang, M., Xiong, Z. et al. · Journal of Clinical Pharmacy and Therapeutics (2019)

Ketamine-Associated Brain Changes: A Review of the Neuroimaging Literature

Ionescu, D. F., Felicione, J. M., Gosai, A. et al. · Harvard Review of Psychiatry (2018)

Prefrontal Connectivity and Glutamate Transmission: Relevance to Depression Pathophysiology and Ketamine Treatment

Abdallah, C. G., Averill, C. L., Salas, R. et al. · Biological Psychiatry (2017)

New Treatment Strategies of Depression: Based on Mechanisms Related to Neuroplasticity

Huang, Y. J., Lane, H. Y., Lin, C. H. · Neural Plasticity (2017)

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Ketamine for Treatment-Resistant Unipolar and Bipolar Major Depression: Critical Review and Implications for Clinical Practice

Bobo, W. V., Vande Voort, J. L., Croarkin, P. E. et al. · Depression and Anxiety (2016)

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