Ketamine and Esketamine in Neurology and Psychiatry: An Overview.
Cureus May 1, 2026 Amalesh S Honnekeri
Ketamine and esketamine, which act on glutamatergic pathways, offer alternative therapeutic approaches for treatment-resistant depression (TRD) when conventional antidepressants fail. Ketamine is typically given intravenously in monitored settings, while esketamine is administered as an intranasal formulation under supervision. This narrative review outlines their proposed mechanisms, clinical uses, administration methods, and safety profiles. Tolerability and monitoring requirements are important considerations. These agents represent a developing area in TRD treatment and highlight the broader emergence of interventional psychiatry. Further research is needed to characterize long-term outcomes, refine protocols, and improve patient selection.