Role of Ketamine in the Treatment of Psychiatric Disorders
Health Psychology Research June 22, 2021 Sahar Derakhshanian, Maxine Zhou, Alexander Rath et al. 21 citations
Treatment-resistant depression (TRD) occurs when major depressive disorder (MDD) does not respond to two adequate trials of antidepressants like SSRIs or SNRIs. MDD involves genetic, pathophysiologic, and environmental factors that disrupt neurotransmitter balance, along with dysregulation of the HPA axis, BDNF, vitamin D, and pro-inflammatory markers. Core symptoms include depressed mood or anhedonia, sleep and appetite changes, worthlessness, guilt, and psychomotor retardation. In 2019, the FDA approved intranasal esketamine (Spravato), an NMDA-receptor antagonist with AMPA-receptor agonist properties, for adult TRD when used with an oral antidepressant. It provides rapid response and is effective and safe. Intravenous ketamine also shows benefits for acute suicidal ideation, depression, and substance use relapse reduction. Off-label uses for ketamine are being studied for PTSD, anxiety disorders, bipolar depression, and substance use disorders.