Ketamine: An Update on Cellular and Subcellular Mechanisms with Implications for Clinical Practice

Area of Science:

• Pharmacology
• Neuroscience
• Anesthesiology

Background:

• Ketamine, an established anesthetic, possesses analgesic properties and minimal respiratory effects.
• Its modulation of N-methyl D-aspartate (NMDA) receptors positions it as a novel treatment for chronic pain.
• Emerging research highlights ketamine's potential in acute depression management and its effects on cognition and development.

Purpose of the Study:

• To review basic science, preclinical, and clinical studies on ketamine.
• To elucidate signaling pathways involved in ketamine's effects on pain, depression, cognition, and neurodevelopment.
• To provide insights into ketamine's multifaceted biological actions.

Main Methods:

• Conducted a narrative literature review.
• Performed a comprehensive search of PubMed, Google Scholar, and Medline (1966-present) using keywords: ketamine, anesthesia, pain, analgesia, depression, NMDA receptors.
• Included English-language articles, with full text reviewed by all authors.

Main Results:

• Reviewed ketamine's evolution from anesthetic to a treatment for depression and pain.
• Explored the pharmacological aspects and biological effects of ketamine.
• Identified potential patient-specific factors contributing to variable clinical responses.

Conclusions:

• Ketamine, an anesthetic with analgesic properties, is a promising agent for chronic pain and depression.
• Its complex pharmacology offers a multifaceted therapeutic approach.
• Understanding patient-specific factors is crucial for optimizing ketamine therapy.