Intravenous Ketamine in Psychiatry: Therapeutic Applications, Mechanisms of Action, and Clinical Perspectives
Juliana Leite Haubman, João Octávio Celante da Silva, Bruno Horta Leonardo Machado de Moura, Paula de Vasconcellos Vargas, Alice Ruiz Garcia, Maria Eduarda Galles Cunha Zambrin, Maria Luiza Kummer, Giovanna Montiel Scherer, Talissa Nadiane Bugs, Helenna Vieira Schvartz
Open Minds International Journal July 6, 2026 Peer reviewed DOI: 10.22533/at.ed.51572142603075 via OpenAlex
Summary
Intravenous esketamine shows promise as a rapid treatment for patients with treatment-resistant depression and severe psychiatric conditions linked to suicidal thoughts. It acts as an NMDA receptor antagonist, leading to quick improvements in symptoms. Benefits have also been noted for anxiety disorders and bipolar disorder. However, concerns about adverse effects like dissociation and blood pressure elevation remain. More long-term studies are necessary to create safe treatment protocols.
Study at a glance
| Design | narrative literature review |
|---|---|
| Population | scientific literature on intravenous esketamine in psychiatry |
| Key finding | Intravenous ketamine produces a rapid antidepressant response in patients refractory to conventional treatments. |
Abstract
Intravenous esketamine represents a significant therapeutic innovation in the field of psychiatry, particularly in the management of treatment-resistant depression and severe psychiatric conditions associated with suicidal ideation.Derived from the S-enantiomer of ketamine, esketamine acts primarily as an N-methyl-D-aspartate (NMDA) receptor antagonist, promoting rapid glutamatergic modulation and brain neuroplasticity.The present study aims to review the scientific literature on the use of intravenous esketamine in psychiatry, addressing its mechanisms of action, clinical indications, therapeutic efficacy, adverse effects, and current challenges.This is a narrative literature review conducted through the analysis of scientific articles indexed in the PubMed, Scielo, MEDLINE, and Google Scholar databases, published between 2015 and 2026, in Portuguese and English.The findings demonstrate that intravenous ketamine produces a rapid antidepressant response, with significant improvement in symptoms among patients refractory to conventional treatments.Furthermore, studies show benefits in anxiety disorders, bipolar disorder, and suicide prevention.However, adverse effects such as dissociation, transient elevation of blood pressure, nausea, and abuse potential still represent significant limitations.It is concluded that intravenous ketamine is a promising and effective alternative in contemporary psychiatry, although further long-term studies are needed to establish safe and standardized protocols.