Ketamine and its enantiomer esketamine show promise for quickly relieving suicidal thoughts in unipolar and bipolar depression, but the evidence is weak. An overview of 26 systematic reviews and 44 randomized controlled trials involving 3,316 subjects found the intervention effective and well-tolerated, but the quality of the included reviews and original studies is poor, resulting in low certainty of evidence. Insufficient data prevent differentiation between effects in unipolar versus bipolar depression. Enhanced methodological rigor in future research is needed to inform treatment guidelines.
Most patients with treatment-resistant depression reported positive experiences with esketamine nasal spray. In a survey of 236 outpatients, 88.4% reported enhanced quality of life. Satisfaction levels varied: 10.2% were unsatisfied, 19.1% partially satisfied, 44.4% satisfied, and 26.3% very satisfied. The most satisfied patients noted early improvements in depressed mood, suicidal thoughts, and restlessness, and reported functional gains across all domains. Artificial intelligence analysis of open-ended responses identified themes of personal growth and a desire for tailored treatment settings. Integrating patient-reported experiences may help personalize care and improve adherence.