Ketamine for treatment-resistant depression: recent developments and clinical applications
This clinical review (2016) examines the fasting-acting effects of ketamine for alleviating symptoms of major depressive disorder (MDD), with regard to its administration method, its safety profile, and its general effects on suicidal ideation, anhedonia, cognition. It also examines which patient profiles predict the most effective response duration while highlighting that the manifestation of depressive symptoms make it challenging to predict the efficacy of ketamine, and although further research is underway to elucidate the role of genetic, central neurobiological, and peripheral measures, it is still too early to recommend their adoption in clinical practice.
Authors
- James Murrough
- Daniel Iosifescu
Published
Abstract
Approximately one-third of patients with major depressive disorder (MDD) do not respond to existing antidepressants, and those who do generally take weeks to months to achieve a significant effect. There is a clear unmet need for rapidly acting and more efficacious treatments. We will review recent developments in the study of ketamine, an old anaesthetic agent which has shown significant promise as a rapidly acting antidepressant in treatment-resistant patients with unipolar MDD, focusing on clinically important aspects such as dose, route of administration and duration of effect. Additional evidence suggests ketamine may be efficacious in patients with bipolar depression, post-traumatic stress disorder and acute suicidal ideation. We then discuss the safety of ketamine, in which most neuropsychiatric, neurocognitive and cardiovascular disturbances are short lasting; however, the long-term effects of ketamine are still unclear. We finally conclude with important information about ketamine for primary and secondary physicians as evidence continues to emerge for its potential use in clinical settings, underscoring the need for further investigation of its effects.
Research Summary of 'Ketamine for treatment-resistant depression: recent developments and clinical applications'
Introduction
Unipolar major depressive disorder (MDD) is highly prevalent and a leading cause of global disability. Existing antidepressants that target monoamine systems relieve symptoms in roughly half of patients and commonly take 6–12 weeks to produce a clinical response. Patients who fail two or more adequate antidepressant trials are classified as having treatment-resistant depression (TRD), a group in which response rates to standard treatments are substantially lower. Emerging evidence implicates glutamatergic dysfunction and impaired neuronal plasticity in depression, which has motivated investigation of non-monoaminergic agents. This review by Schwartz and colleagues examines recent developments in the clinical use of ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist and established anaesthetic, as a rapidly acting antidepressant for TRD. The authors focus on clinically important questions such as effective dose, route of administration, duration of benefit and safety, and they consider evidence for ketamine in bipolar depression, PTSD and acute suicidal ideation. The review aims to inform primary and specialty clinicians about current evidence and gaps that bear on clinical application.
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Study Details
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- APA Citation
Schwartz, J., Murrough, J. W., & Iosifescu, D. V. (2016). Ketamine for treatment-resistant depression: recent developments and clinical applications. Evidence Based Mental Health, 19(2), 35-38. https://doi.org/10.1136/eb-2016-102355
References (12)
Papers cited by this study that are also in Blossom
Papakostas, G. I., Ionescu, D. F. · Molecular Psychiatry (2015)
Murrough, J. W., Iosifescu, D. V., Chang, L. C. et al. · American Journal of Psychiatry (2013)
Fond, G., Loundou, A., Macgregor, A. et al. · Psychopharmacology (2014)
Murrough, J. W., Wan, L., Levitch, C. F. et al. · Journal of Clinical Psychiatry (2015)
Romeo, B., Choucha, W., Fossati, P. et al. · Psychiatry Research (2015)
Feder, A., Parides, M. K., Murrough, J. W. · JAMA Psychiatry (2014)
Murrough, J. W., Burdick, K. E., Levitch, C. F. et al. · Neuropsychopharmacology (2014)
Monteggia, L. M., Zarate, C. A. · Current Opinion in Neurobiology (2015)
Murrough, J. W., Perez, A. M., Pillemer, S. et al. · Biological Psychiatry (2012)
Serafini, G., Howland, R. H., Rovedi, F. et al. · Current Neuropharmacology (2014)
Show all 12 referencesShow fewer
Nutt, D. J. · Journal of Psychopharmacology (2015)
Murrough, J. W., Collins, K. A., Fields, J. et al. · Translational Psychiatry (2015)
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Conley, A. A., Norwood, A. E. Q., Hatvany, T. C. et al. · Psychopharmacology (2021)
Lascelles, K., Marzano, L., Brand, F. et al. · BJPsych Open (2020)
Zhang, J., Tian, H., Li, J. et al. · Psychiatry Research (2020)
Liu, F., Gong, Y., Wang, P. et al. · Progress in Neuro-Psychopharmacology and Biological Psychiatry (2017)
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