The Role of Ketamine in Depression

Ketamine infusions may provide short-term relief for depressive symptoms, including suicidal ideation, in patients with treatment-resistant depression who have not responded to at least two medication trials. This review examines clinical trials on ketamine for refractory depression, assessing its benefits, limitations, and future potential. Standard therapies for treatment-resistant depression include combination pharmacotherapy, electroconvulsive therapy, transcranial magnetic stimulation, vagal nerve stimulation, and deep brain stimulation.

Study at a glance

Abstract

Background: Introduction: The average person has up to 15% lifetime risk for developing depression. Major depressive disorder symptoms can include a depressed mood, such as feeling sad or having more anger than normal, changes in appetite, loss of interest in activities or hobbies, psychomotor agitation or retardation, loss of energy, feelings of worthlessness or guilt, decreased ability to think or concentrate, sleep disturbance, an/or having suicidal thoughts. To make the diagnosis of major depressive disorder, according to the DSM-V, Diagnostic and Statistical Manual of Mental disorders, a person must have at least 5 or more of these 9 symptoms during a continuous two-week period which causes significant impairment in functioning. Depression is treated in a variety of ways including medications and psychotherapy either as monotherapy or in tandem. When a patient has failed 2 or more medication treatments they are considered treatment resistant or as having refractory depression. Treatment resistant depression or refractory depression has several standard therapies, which include combination pharmacotherapy, electroconvulsive therapy, or ECT, transcranial magnetic stimulation, or TMS, vagal nerves stimulation and deep brain stimulation. Current research does support that a novel therapy, such as ketamine infusions, may help patients in the short-term with their depressive symptoms, including suicidal ideation. The focus of this paper is to review the clinical trials involving ketamine use in refractory depression for the alleviation of depressive symptoms, including suicidal ideation, and to examine the benefits, limitations, and future potential for ketamine as a treatment for refractory depression.