J Korean Soc Biol Ther Psychiatry.  2020 Jun;26(2):79-87.

The Antidepressant Effects and Clinical Implication of Ketamine

• Kim BS

Abstract

Major depressive disorder is a highly prevalent psychiatric condition that causes serious health concern and psychosocial consequences. Nevertheless, about one third of the patients with major depressive disorder have treatmentresistant depression (i.e., a failure to respond to two or more antidepressant drugs). In addition, it takes at least two weeks to several months before the antidepressants have an effect. In the field of emergency psychiatry, this time lag has always been a serious obstacle in the treatment of suicidal patients. Since 2000, the ketamine has emerged as a novel therapeutic agent for major depressive disorder and suicidality with rapid onset and robust response rates. In 2019, the U.S. Food and Drug Administration (U.S. FDA) approved the S-enantiomer of ketamine, esketamine as a drug for treatment-resistant depression. However, the U.S. FDA approved it with a Risk Evaluation and Mitigation Strategy (REMS) to mitigate the risk of serious adverse effects resulting from sedation, dissociation, cardiovascular instability, and potential abuse. Although we still do not have enough experience about the efficacy and safety of this new medication, the interests of clinicians and patients are rapidly growing. In this narrative review, the pharmacological characteristics, the mechanism of action, the psychiatric effects and side effects, and a consensus statement on the use of ketamine were provided.

Keyword

Ketamine; Esketamine; Depressive disorder; Suicide; Antidepressive agents