The role of ketamine in the treatment of treatment-resistant bipolar depression
Grigorios N. Karakatsoulis, Eva-Maria Tsapakis, Konstantinos Ν. Fountoulakis
Psychiatriki December 20, 2021 DOI: 10.22365/jpsych.2021.052 via OpenAlex
Summary
AI-generated from the abstractTreatment-resistant depression (TRD) requires effective mood-elevating interventions. Ketamine and its S-enantiomer esketamine have shown effectiveness in TRD through successful clinical trials. In 2019, the FDA approved intranasal esketamine for TRD, although intravenous ketamine is more effective. Esketamine treatment carries major adverse effects including psychosis risk, abuse and dependence potential with repeated use, transient changes in blood pressure and heart rate, and toxicity to the urothelium and liver. These risks are minimized when dosing is within the recommended range and administration is by experienced personnel. The benefits of esketamine appear to offset these risks across depressive symptoms like anhedonia, anxiety, cognitive impairment, suicidality, and dysfunction. The review calls for more phase 4 studies evaluating real-life long-term effectiveness and risks.
Study at a glance
| Characteristics | Review Peer reviewed |
|---|---|
| Interventions | Esketamine Ketamine |
| Topics | Anxiety Depression Ketamine |
| Keywords | Bipolar disorder Adverse effect |
| Citations | 1 |
| Key finding | Esketamine is effective for treatment-resistant depression but carries major adverse effects that are minimized with proper dosing and administration, and the benefits appear to offset the risks across a range of depressive symptoms. |
Abstract
Treatment-Resistant Depression (TRD) calls for the development of effective interventions for mood elevation and stabilization. Recently, both ketamine and its S-enantiomer (esketamine) have been investigated with successful clinical trials demonstrating effectiveness in TRD. More specifically, in 2019, intranasally administered esketamine, as opposed to the more effective intravenous ketamine, has been approved by the FDA as a treatment option for TRD. Treatment with esketamine, however, potentially comes with major adverse effects, including risk of psychosis, the possibility of abuse and dependence after repeated use, transient but non-negligible change in blood pressure and the heart rate, and potential toxicity on the urothelium and the liver. These risks are minimized when treatment is kept within the recommended dose range and the drug is administered by experienced medical personnel. Nevertheless, these risks appear to be offset by the effectiveness of esketamine in a wide range of depressive symptoms, such as anhedonia, anxiety, cognitive impairment, suicidality, and general dysfunction. This review highlights the need for more phase 4 clinical studies to evaluate esketamine's performance in real life, including long-term effectiveness and risk studies.