International Journal of Neuropsychopharmacology
December 4, 2021
Joakim Ekstrand, Christian Fattah, Marcus Persson et al.
112 citations
For severely depressed inpatients aged 18–85, electroconvulsive therapy (ECT) led to remission in 63% of patients, while ketamine infusions led to remission in 46%, a statistically significant difference. Both treatments required a median of six sessions to achieve remission. ECT caused more serious and long-lasting side effects, including persisting amnesia, whereas ketamine caused more treatment-emergent adverse events leading to dropouts. Among those who remitted, about two-thirds in each group relapsed within 12 months, with no significant difference between treatments. Ketamine, though less effective than ECT, appears to be a safe and useful option for treating unipolar depression.
International Journal of Neuropsychopharmacology
April 30, 2021
A. Bahji, C. Zarate, G. Vázquez
62 citations
Ketamine appears to help treat bipolar depression, though evidence is preliminary. A systematic review of six studies involving 135 adults (53% female, average age 44.7 years) found that 61% of those receiving intravenous racemic ketamine (0.5 mg/kg, added to a mood stabilizer) achieved at least a 50% reduction in depression severity, compared to 5% receiving placebo. Response rates across studies ranged from 52% to 80%. Ketamine was reasonably well tolerated, but two participants developed manic symptoms (one on ketamine, one on placebo), and some experienced significant dissociative symptoms 40 minutes after infusion in two trials. Longer-term outcomes and alternative formulations need further study.
International Journal of Neuropsychopharmacology
March 26, 2023
T. Su, Cheng-Ta Li, Wei-Chen Lin et al.
48 citations
A single low-dose ketamine infusion (0.5 mg/kg) produces an antidepressant effect lasting up to 14 days in outpatients with treatment-resistant depression and prominent suicidal thoughts, compared with a low-dose midazolam control. The antisuicidal effect, however, persists only 5 days. The benefits are most pronounced in patients whose current depressive episode has lasted less than 24 months or who have failed four or fewer prior antidepressants. The treatment is safe and well tolerated.
International Journal of Neuropsychopharmacology
June 25, 2021
J. Veraart, S. Smith-Apeldoorn, I. M. Bakker et al.
44 citations
Benzodiazepines and possibly lamotrigine reduce the antidepressant effects of ketamine, while lithium shows no significant interaction. Evidence from 24 studies indicates that clozapine, haloperidol, and risperidone interact with ketamine, though findings are mixed and based on low-quality evidence due to small sample sizes and varied methods. The review highlights the need for caution when combining ketamine with these drugs in psychiatric treatment.
International Journal of Neuropsychopharmacology
May 5, 2020
Ziad S. Saad, D. Hibar, M. Fedgchin et al.
43 citations
A genetic variant in the mu-opioid receptor (OPRM1 A118G) did not alter the antidepressant response to esketamine plus an oral antidepressant in people with treatment-resistant depression. In the placebo-plus-antidepressant group, carriers of the G allele showed greater improvement in depression scores on day 2, with a similar trend at day 28, suggesting that endogenous opioids may contribute to the placebo response. No genetic effect was observed on dissociative side effects from esketamine.
International Journal of Neuropsychopharmacology
September 25, 2023
Szabolcs Koncz, Noémi Papp, Dóra Pothorszki et al.
29 citations
Racemic ketamine contains two mirror-image molecules, (R)-ketamine and (S)-ketamine, which have different effects. (S)-ketamine is approved for treating major depression, but (R)-ketamine failed in recent clinical trials. In rats, a single dose of (S)-ketamine, but not (R)-ketamine, delayed the onset of rapid eye movement (REM) sleep, reduced total REM sleep time, and increased slow-wave activity during non-REM sleep. (S)-ketamine also increased wakefulness and decreased non-REM sleep in the first two hours. In chronically stressed rats, only (S)-ketamine reduced immobility in the forced swimming test, indicating antidepressant-like activity. The two enantiomers produce markedly different effects on sleep-wake patterns and behavior at the same dose.
International Journal of Neuropsychopharmacology
June 1, 2024
Mina M Rizk, James W Murrough
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