Ketamine
January 1, 2025
Jose Eduardo Guimaraes Pereira, Carlos Darcy Alves Bersot, Thiago Ramos Grigio et al.
1 citation
Ketamine can help manage chronic neuropathic pain, which is often undertreated. Intravenous racemic ketamine at 0.5–1.5 mg/kg/day for 4–5 days is recommended as an initial hospital-based approach, providing pain relief lasting 1–3 months. Non-IV administration with de-escalating doses can then be tailored to individual patients, and infusions may be repeated quarterly if necessary. Neurocognitive side effects can cause discomfort or treatment discontinuation, but psychological guidance and GABA-ergic agents can reduce adverse effects. Despite some challenges, the potential benefits often outweigh the risks. Further high-quality trials are urgently needed to refine ketamine use for neuropathic pain.
Ketamine
January 1, 2025
Katarina Savić Vujović, Ana Jotić, Branislava Medić et al.
1 citation
Ketamine shows promise as a treatment for alcohol, opioid, and cocaine use disorders by reducing cravings, withdrawal symptoms, and relapse rates. Its effects stem from N-methyl-D-aspartate receptor antagonism, rapid-acting antidepressant properties, and ability to modulate glutamatergic transmission and promote neural plasticity. Challenges remain regarding optimal dosing, long-term safety, and abuse potential. Further rigorous clinical trials are needed to establish ketamine's role as an adjunctive therapy in addiction treatment.
Ketamine
January 1, 2025
Carson Chrenek, Jennifer Swainson
Access to effective ketamine treatments for treatment-resistant depression is limited by cost, availability, and monitoring requirements. This article synthesizes current literature on ketamine's pharmacology and describes its application in a clinical program in Edmonton, Alberta. Topics include the rationale for maintenance treatments, monitoring long-term safety, and alternative options such as sublingual or at-home ketamine to improve patient access. The authors review considerations for cautious prescribing outside highly monitored settings.
Ketamine
January 1, 2025
Pouya Movahed Rad, Akihiro Takamiya
Electroconvulsive therapy (ECT) and racemic ketamine are both effective treatments for severe major depressive disorder, but they target different patient populations. Systematic reviews show higher remission rates with ECT than with ketamine. However, ketamine acts rapidly and causes less cognitive side effects, making it valuable for outpatients or when ECT is unavailable. ECT induces transient cognitive impairments, while ketamine commonly causes dissociative symptoms. Older patients and those with psychotic symptoms respond better to ECT, whereas younger patients with longer episode duration may benefit similarly from ketamine. Although biological variables and brain imaging hold promise as biomarkers, their clinical use remains limited. The review advocates integrating clinical predictors with patient characteristics to personalize treatment.