Journal of Psychiatric Research
September 1, 2018
Li Ren, Jie Deng, S. Min et al.
48 citations
Electroconvulsive therapy (ECT) is highly effective for depression, and ketamine at sub-anesthetic doses also produces rapid antidepressant effects. This systematic review and meta-analysis of 16 randomized controlled trials involving 928 patients examined whether adding ketamine to ECT improves outcomes. At the end of the ECT course, depressive symptoms were not significantly lower in the ketamine group compared to controls. However, depressive scores were lower after the first and after the third through sixth ECT sessions, particularly when ketamine was used as an add-on anesthetic. Ketamine did not improve overall response or remission rates and increased adverse events, especially cardiovascular and psychiatric side effects. Ketamine may accelerate antidepressant effects during ECT but should be used cautiously due to added risks.
Psychiatry Research
November 1, 2019
Jun Dong, S. Min, H. Qiu et al.
26 citations
For patients with major depressive disorder, adding a low dose of ketamine to electroconvulsive therapy (ECT) once a week improved remission rates and reduced psychiatric complications compared with giving ketamine before every ECT session. In a randomized trial of 134 patients, those receiving intermittent ketamine had a complication rate of 4.35%, far lower than the 20.93% rate in the repeated-ketamine group and similar to the 0% rate in the routine ECT group. Both ketamine regimens led to higher remission than ECT alone. Intermittent low-dose ketamine appears to boost ECT's effectiveness while minimizing side effects.
Journal of ECT
January 6, 2020
Qibin Chen, Jun Dong, Jie Luo et al.
22 citations
Adding a low dose of ketamine to electroconvulsive therapy (ECT) for major depressive disorder does not improve overall response, remission, or relapse rates, but it does speed up the treatment's effects. Patients receiving 0.3 mg/kg ketamine before ECT required fewer sessions to achieve a response (median 4 vs. 7 sessions) and remission (median 8 vs. 9 sessions), and also reduced suicidal ideation more quickly (median 3 vs. 6 sessions). The findings suggest ketamine can accelerate the onset of ECT's antidepressant benefits without affecting long-term relapse.
JAMA network open
February 3, 2025
Li Ren, Ting Zhang, Bingyu Zou et al.
13 citations
A single-site randomized clinical trial at a Chinese hospital found that administering a low dose of esketamine during cesarean delivery significantly reduced the incidence of postpartum depression at six weeks. Among 308 women, 10.4% who received esketamine developed postpartum depression compared with 19.5% who received a placebo saline infusion, a relative risk of 0.53. The authors suggest esketamine shows promise for preventing postpartum depression in this setting but call for further research in broader clinical practice.
Pharmacology, biochemistry, and behavior
March 1, 2025
Yiwei Shen, Wei Ran, Dawei Liu et al.
2 citations
Electroconvulsive therapy (ECT) effectively treats depression but impairs learning and memory. Ketamine may reduce these cognitive side effects. Using a rat model of depression, researchers tested whether esketamine (a ketamine derivative) protects memory after electroconvulsive shock (ECS), the animal analogue of ECT. A low dose of esketamine increased the expression of metabotropic glutamate receptor 5 (mGluR5) and NMDA receptor 1 in the hippocampus, reduced ECS-induced memory impairment, and improved depressive-like behavior. Blocking mGluR5 with the antagonist MTEP reversed these effects. The findings suggest esketamine protects spatial learning and memory after ECS by upregulating mGluR5 and enhancing NMDA receptor activation.
Obstetric Anesthesia Digest
November 18, 2025
Li Ren, Ting Zhang, B Zou et al.
1 citation
Postpartum depression affects about 17.7% of new mothers globally and 21.4% in China. Cesarean birth increases the risk of developing postpartum depression compared to vaginal birth. Esketamine, a rapid-acting antidepressant derived from ketamine, has shown mixed results in prior randomized clinical trials for preventing postpartum depression, with limited real-world evidence of its effectiveness. This study examined the practical impact of esketamine in reducing the risk of postpartum depression following cesarean delivery.
National Science Review
September 5, 2025
Huoqing Luo, Ming Chen, Yingjie Ning et al.
1 citation
Ketamine produces rapid antidepressant effects by both blocking NMDA receptors and increasing serotonin levels through inhibition of the serotonin transporter (SERT). A cryogenic electron microscopy structure shows ketamine binding to SERT's central site. The elevated serotonin activates vasoactive intestinal peptide (VIP)-expressing interneurons, a cell type essential for ketamine's rapid effects. Inhibiting these neurons blocks the antidepressant actions, identifying a specific neural pathway. This dual mechanism offers potential strategies for developing rapidly acting antidepressants.
Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition
March 20, 2025
Congli Zhang, Yan Yan, Junjie Ma et al.
1 citation
In a double-blind randomized trial, 82 frail elderly patients undergoing thoracoscopic radical resection of lung cancer received either intravenous esketamine or a placebo (normal saline) during surgery. Those given esketamine had significantly lower depression scores (HAMD-17) at 7 and 30 days after surgery, indicating less postoperative depression. They also reported better sleep quality in the first week and showed higher scores on a cognitive function test (MMSE) in the first month. Esketamine was associated with higher levels of serum BDNF and 5-HT, lower levels of S100β and NSE, reduced use of anesthetic drugs, fewer side effects like nausea and hyperalgesia, and shorter stays in the recovery room and hospital. Esketamine appears to improve postoperative depressive state, sleep, and cognitive function in this vulnerable group.
Drug design, development and therapy
January 1, 2026
Jie Yang, Qiqi Yan, Ting Zhang et al.
Among women without prenatal depression who delivered by caesarean section, a single bolus injection of 0.25 mg/kg esketamine reduced the rate of postpartum depression (PPD) at six weeks to 9.15%, compared with 19.33% in the saline placebo group. Continuous infusion of the same dose produced a PPD rate of 11.54%, which did not differ statistically from the bolus group. Pain scores were similar across all three groups. The bolus route caused fewer intraoperative adverse events—45.75% versus 65.38% with infusion—especially less dizziness and nausea or vomiting. For preventing PPD, bolus and continuous infusion appear equally effective, but bolus administration may be preferable because it is better tolerated.