Depression in adolescents is difficult to treat, especially when accompanied by suicidal thoughts or when it does not respond to standard treatments. Treatment-resistant depression affects up to 40% of adolescents with major depressive disorder and can severely impair development and quality of life. A review of existing research suggests that ketamine reduces depressive symptoms in adolescents with treatment-resistant depression, while esketamine reduces both depressive symptoms and suicidal ideation. Both drugs show favorable safety and tolerability. Prompt treatment with these medications may lower suicide risk and create an opportunity for longer-term therapies, though more research is needed to optimize protocols and assess long-term effects.
In a real-world clinic, intravenous ketamine reduced depressive symptoms in patients with treatment-resistant unipolar and bipolar depression. Both groups improved significantly, but those with bipolar depression showed faster and greater improvement starting at two weeks and lasting through three months. Dissociative side effects were mild and did not increase over time; women with unipolar depression reported higher dissociative symptoms at three months. No sex differences in antidepressant efficacy were found. The findings suggest ketamine is effective for treatment-resistant depression, with stronger benefits for bipolar depression.