Ketamine and esketamine for treatment of mood disorders: literature review

Austėja Rimkutė1, Algirdas Musneckis2

1Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lithuania

2Lithuanian University of Health Sciences Kaunas Hospital, Department of Psychiatry, Kaunas, Lithuania


Introduction. Traditional antidepressants act on serotonin, noradrenaline, and dopamine receptors. Improvement in symptoms is usually observed in 6-8 weeks after initiating the treatment. Furthermore, treatment-resistant depression is prevalent in one third of the cases. Depression treatment would benefit greatly from a medication that would induce a faster response. For this reason, there is a rising interest in ketamine. Ketamine has been used as an anesthetic for a few decades now. It was noticed that ketamine also has a fast-acting antidepressant effect. Ketamine is a racemic mixture made of (S)-ketamine (esketamine) and (R)-ketamine. Racemic ketamine was patented in 1963 while esketamine is a new medication that was registered in European Union in 2019. Ketamine is prescribed for depression off-label, meanwhile esketamine is an approved medication for treatment resistant depression. At the moment, there isn’t a consensus on the role of ketamine and esketamine in psychiatry, on which medication is more effective and safer in treatment of mood disorders, and which one has a greater extent of use (e.g., effective for bipolar disorder).

Aim: to analyze recent publications on ketamine and esketamine and to prepare a comparison on pharmacodynamics, efficacy, safety, unwanted side effects and scope of use of ketamine versus esketamine.

Materials and methods. 20 research publications were selected from PubMed, ScienceDirect and Wiley Online Library electronic journals using keywords “ketamine” AND “esketamine” AND “depression” OR “suicide ideation” OR “bipolar disorder”. All included studies were published between 2016 and 2022.

Results. A thorough comparison between ketamine and esketamine as well as some prescribing recommendations were presented.

Keywords: ketamine, esketamine, treatment resistant depression, suicide ideation.

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