Advances in ketamine therapy for multiple psychiatric disorders
Sichuan jingshen weisheng September 5, 2025 Zhang Kai, Cheng Zhaoyang, Wang Yuting
Ketamine, a non-competitive NMDA receptor antagonist, produces rapid antidepressant effects in treatment-resistant depression and suicidal ideation through NMDA receptor blockade, AMPA receptor activation, and upregulation of BDNF/mTOR signaling. Its enantiomers esketamine and R-ketamine differ in efficacy and mechanisms. Intranasal esketamine has been approved in Europe, the United States, and China for treatment-resistant depression, showing rapid alleviation of depressive symptoms and acute suicidal ideation. R-ketamine may offer longer-lasting effects and an improved safety profile. Safety concerns include dissociation, cognitive impairment, and abuse liability.