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Area of Science:

  • Neuroscience
  • Pharmacology
  • Psychiatry

Background:

  • Ketamine, a racemic mixture of R- and S-ketamine, is used for anesthesia and analgesia.
  • S-ketamine (esketamine) exhibits more potent analgesic and anesthetic effects with fewer adverse effects than R-ketamine.
  • Emerging research explores the antidepressant potential of S-ketamine.

Purpose of the Study:

  • To review preclinical and clinical data on the antidepressant properties of S-ketamine.
  • To evaluate the efficacy of S-ketamine in patients with treatment-resistant depression.
  • To compare the antidepressant effects of S-ketamine with racemic ketamine and R-ketamine.

Main Methods:

  • Review of preclinical (animal) studies.
  • Analysis of clinical literature including case reports, case series, and randomized controlled trials.
  • Examination of S-ketamine administration via intravenous infusions and intranasal routes.

Main Results:

  • Animal data suggest potential advantages for R-ketamine in some aspects.
  • Clinical studies indicate that S-ketamine has antidepressant action in patients with medication-refractory depression.
  • Observed antidepressant benefits of S-ketamine appear comparable in magnitude to those of racemic ketamine.

Conclusions:

  • S-ketamine demonstrates antidepressant activity in treatment-resistant depression.
  • Current evidence suggests S-ketamine's antidepressant efficacy is similar to racemic ketamine.
  • Direct comparative studies are needed to determine the optimal choice between S-ketamine, R-ketamine, and racemic ketamine for depression.