The role of ketamine in the treatment of treatment-resistant bipolar depression
Psychiatriki December 20, 2021 Grigorios N. Karakatsoulis, Eva-Maria Tsapakis, Konstantinos Ν. Fountoulakis 1 citation
Treatment-resistant depression (TRD) requires effective mood-elevating interventions. Ketamine and its S-enantiomer esketamine have shown effectiveness in TRD through successful clinical trials. In 2019, the FDA approved intranasal esketamine for TRD, although intravenous ketamine is more effective. Esketamine treatment carries major adverse effects including psychosis risk, abuse and dependence potential with repeated use, transient changes in blood pressure and heart rate, and toxicity to the urothelium and liver. These risks are minimized when dosing is within the recommended range and administration is by experienced personnel. The benefits of esketamine appear to offset these risks across depressive symptoms like anhedonia, anxiety, cognitive impairment, suicidality, and dysfunction. The review calls for more phase 4 studies evaluating real-life long-term effectiveness and risks.