[Ketamine and esketamine in treatment-resistant depression - Pharmacological effects and augmented psychotherapy].
Fortschr Neurol Psychiatr May 13, 2026 Cornelius Schüle, Anna Sobieraj, Helena Rogg 1 citation
Esketamine, an NMDA receptor antagonist, is approved as a nasal spray for treatment-resistant major depression and for rapid symptom reduction in psychiatric emergencies. In the US it is also approved as a monotherapy for treatment-resistant depression. Acute treatment often causes dissociative effects, but a link between these initial symptoms and later therapeutic response is not sufficiently proven. A key methodological problem is functional unblinding, where characteristic side effects reveal group assignment. Proponents of ketamine-augmented psychotherapy suggest that ketamine-induced synaptic plasticity opens a 'therapeutic window' for psychotherapy, but current research methods cannot adequately test causal relationships due to unblinding and general limitations of psychotherapy studies.