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Ketamine for Depression, 2: Diagnostic and Contextual Indications
1Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India. candrade@psychiatrist.com.
The Journal of Clinical Psychiatry
|June 2, 2017
Summary
Subanesthetic ketamine shows promise for treating major depressive episodes, especially severe or treatment-resistant cases. Its rapid action is beneficial for reducing suicidal thoughts and in urgent situations.
Area of Science:
- Psychiatry and Pharmacology
- Neuroscience of Mood Disorders
Background:
- Growing body of literature on subanesthetic ketamine for major depressive episodes.
- Includes anecdotal reports, uncontrolled, and randomized controlled trials.
- Focuses on off-label therapeutic applications.
Purpose of the Study:
- Examine diagnostic indications for off-label ketamine use in depression.
- Identify contexts suitable for ketamine trials.
- Review ketamine's efficacy in major depressive disorder and bipolar depression.
Main Methods:
- Review of existing literature and clinical trial data.
- Analysis of diagnostic criteria and patient populations.
- Exploration of specific clinical scenarios for ketamine intervention.
Main Results:
- Ketamine is effective for major depressive episodes in both major depressive disorder and bipolar depression.
- Benefits are temporary, potentially shorter in bipolar depression.
- Efficacy demonstrated in rapid reduction of suicidal symptoms.
Conclusions:
- Ketamine trials are indicated for severe, treatment-refractory depression, and when rapid suicidality reduction is needed.
- Consideration for patients requiring urgent improvement for life circumstances.
- Potential benefits when used early in antidepressant trials or with electroconvulsive therapy.
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