KETAMINE FOR TREATMENT-RESISTANT UNIPOLAR AND BIPOLAR MAJOR DEPRESSION: CRITICAL REVIEW AND IMPLICATIONS FOR CLINICAL PRACTICE

• Published in: Depression and anxiety Vol. 33; no. 8; pp. 698 - 710
• Main Authors: Bobo, William V., Voort, Jennifer L. Vande, Croarkin, Paul E., Leung, Jonathan G., Tye, Susannah J., Frye, Mark A.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.08.2016; John Wiley & Sons, Inc
• Subjects: Antidepressive Agents - therapeutic use; bipolar depression; Bipolar disorder; Bipolar Disorder - drug therapy; Depressive Disorder, Major - drug therapy; Depressive Disorder, Treatment-Resistant - drug therapy; Electroconvulsive therapy; Humans; Ketamine; Ketamine - therapeutic use; major depression; Mental depression; Treatment resistance; treatment-resistant depression; bipolar depression; treatment-resistant depression; bipolar disorder; ketamine; major depression
• ISSN: 1091-4269; 1520-6394; 1520-6394
• DOI: 10.1002/da.22505

There is an urgent need for more rapidly effective pharmacotherapies for major depressive disorder and bipolar disorder (BP) that are efficacious and tolerable for depressed patients who respond poorly to conventional treatments. Multiple controlled trials have now demonstrated a rapid, nonsustained antidepressive response to a single intravenous infusion of ketamine. Early controlled studies of intranasal or serial infusion therapy appear promising. The effective dose for depression is lower than the typical anesthetic doses, and side‐effects are generally mild and transient. The data investigating the adjunctive use of concurrent ketamine in the course of electroconvulsive therapy (ECT) for depression do not suggest efficacy or tolerability. The therapeutic potential of ketamine has stimulated considerable excitement among clinicians, patients, and industry, and has led to the increasing use of ketamine as an off‐label substitute for ECT and other antidepressive treatments. This clinical review of ketamine will assess the evidence‐based use of ketamine and initial clinical implications of further development of a potentially novel treatment for rapid reduction of symptoms in depressed patients.