Ketamine for refractory depression: Save the best for last?
Journal of psychopharmacology (Oxford, England) – January 01, 2025
Source: PubMed
Summary
Ketamine, traditionally an anesthetic, shows remarkable promise in treating severe depression, matching the effectiveness of electroconvulsive therapy with fewer side effects. Rather than being a last resort, new pharmacology research suggests it could work better as an early treatment option. Current treatment algorithms place ketamine after multiple failed medications, but evidence shows it's safer than many standard augmentation strategies. For patients with treatment-resistant depression, earlier ketamine intervention could mean faster relief and better outcomes.
Abstract
Ketamine has recently been shown to be non-inferior to electroconvulsive therapy (ECT), one of psychiatry's most effective treatments for depression. Given the novelty of ketamine as well as its interventional nature, ketamine is currently viewed as an alternative to ECT and as such, considered a third-line agent for treatment-refractory depression. However, available data suggest that ketamine carries a low side-effect burden and is better tolerated than many second-line augmentation strategies for depression. With this combination of higher efficacy and lower side-effect burden in conjunction with what is known about treatment outcomes in relation to the duration of untreated illness, it is in the best interest of patients for the field of psychiatry to evaluate ketamine as a second-line augmentation strategy for refractory depression.