Frontiers in psychiatry
January 1, 2023
Carson Chrenek, Bryan Duong, Atul Khullar et al.
23 citations
Intravenous ketamine and intranasal esketamine are effective for treatment-resistant depression but are limited by cost, availability, and monitoring requirements. A literature review up to June 2023 and a community case study from two public hospital sites in Edmonton, Canada, describe how evidence on ketamine for treatment-resistant depression can be applied in real-world settings. The paper synthesizes knowledge on off-label racemic ketamine versus FDA-approved esketamine, dosing, safety, and long-term maintenance. To overcome cost barriers, public programs may incorporate sublingual or intranasal ketamine. Three such sustainable treatment models are described, though large-scale randomized trials and long-term outcome data remain lacking.
Frontiers in psychiatry
January 1, 2022
Ryan Yip, Jennifer Swainson, Atul Khullar et al.
13 citations
Ketamine is increasingly used for treatment-resistant depression, but its intravenous administration often causes transient high blood pressure. Current psychiatric guidelines recommend aggressive monitoring and treatment of these hypertensive episodes. This review argues that those guidelines should be updated to align with standard best practices for managing hypertension, distinguishing between hypertensive emergency and asymptomatic hypertensive urgency. Adopting such an updated protocol could make ketamine therapy safer and more accessible for patients with depression.
Therapeutic advances in psychopharmacology
January 1, 2024
Raymond Yan, Tyler Marshall, Atul Khullar et al.
11 citations
Over a 4-week course of eight intravenous ketamine infusions, adults with treatment-resistant depression reported improved sleep quality and an earlier circadian rhythm. Sleep quality, measured by the Pittsburgh Sleep Quality Index, improved significantly, as did depressive symptoms. Circadian rhythm, measured by the Morningness-Eveningness Questionnaire, shifted earlier. Improvements in sleep duration and daytime dysfunction were also observed. The effect on sleep quality was more prominent in patients with mixed features of depression, while the circadian shift was more prominent in those without mixed features. The study was small and uncontrolled, so findings are preliminary.
Psychiatry research
September 1, 2026
Isis Lunsky, Gilmar Gutierrez, Xena Wang et al.
Postpartum depression (PPD) is common and harmful if untreated, with few effective prevention strategies. Ketamine and esketamine are rapid-acting antidepressants showing promise for PPD. This review searched five databases for peer-reviewed randomized controlled trials, pilot studies, and observational studies examining ketamine or esketamine for PPD prevention during pregnancy or postpartum, for both cesarean and vaginal deliveries. A network meta-analysis and narrative synthesis were used. Thirty-six studies were identified; five included vaginal delivery, thirty included cesarean section, and one did not specify delivery mode. Results suggested that ketamine and esketamine were well tolerated and may reduce PPD risk. However, data quality was low to very low, so results should be interpreted cautiously. More high-quality studies are needed.