Ketamine as a therapeutic agent for depression and pain: mechanisms and evidence.
Subha Subramanian, S. Haroutounian, B. Palanca, E. Lenze
Journal of Neurological Sciences January 1, 2022 DOI: 10.1016/j.jns.2022.120152 via Semantic Scholar
Summary
Ketamine, an anesthetic and NMDA receptor antagonist, is used to treat chronic pain and depression, conditions that often co-occur and may share neural pathways. Intravenous and intranasal ketamine are both effective for acute depressive episodes, with intravenous administration having higher bioavailability and providing better post-operative pain relief while reducing opioid use. Few studies have addressed ketamine's effects on concurrent depression and pain. Larger randomized controlled trials are needed to compare the safety and efficacy of intravenous versus intranasal ketamine, identify ideal target populations, and determine optimal dosing for treating both conditions.
Study at a glance
| Characteristics | Review Randomized Peer reviewed |
|---|---|
| Keywords | Medicine Psychology |
| Citations | 58 |
| Key finding | Intravenous and intranasal ketamine are both effective for acute depressive episodes, and intravenous ketamine is advantageous for post-operative analgesia with reduced opioid requirements, but more research is needed on treating concurrent depression and pain. |
Abstract
Ketamine is an anesthetic drug which is now used to treat chronic pain conditions and psychiatric disorders, especially depression. It is an N-methyl-D-aspartate (NMDA) receptor antagonist with additional effects on α-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, hyperpolarization-activated cyclic nucleotide-gated (HCN) channels, opioid receptors, and monoaminergic receptors. This article focuses on ketamine's role in treating depression and pain, two commonly comorbid challenging conditions with potentially shared neurobiologic circuitry. Many clinical trials have utilized intravenous or intranasal ketamine for treating depression and pain. Intravenous ketamine is more bioavailable than intranasal ketamine and both are effective for acute depressive episodes. Intravenous ketamine is advantageous for post-operative analgesia and is associated with a reduction in total opioid requirements. Few studies have treated chronic pain or concurrent depression and pain with ketamine. Larger, randomized control trials are needed to examine the safety and efficacy of intravenous vs. intranasal ketamine, ideal target populations, and optimal dosing to treat both depression and pain.