TY - JOUR
T1 - Ketamine as a therapeutic agent for depression and pain
T2 - mechanisms and evidence
AU - Subramanian, Subha
AU - Haroutounian, Simon
AU - Palanca, Ben Julian A.
AU - Lenze, Eric J.
N1 - Publisher Copyright:
© 2022 Elsevier B.V.
PY - 2022/3/15
Y1 - 2022/3/15
N2 - Ketamine is an anesthetic drug which is now used to treat chronic pain conditions and psychiatric disorders, especially depression. It is an N-methyl-D-aspartate (NMDA) receptor antagonist with additional effects on α-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, hyperpolarization-activated cyclic nucleotide-gated (HCN) channels, opioid receptors, and monoaminergic receptors. This article focuses on ketamine's role in treating depression and pain, two commonly comorbid challenging conditions with potentially shared neurobiologic circuitry. Many clinical trials have utilized intravenous or intranasal ketamine for treating depression and pain. Intravenous ketamine is more bioavailable than intranasal ketamine and both are effective for acute depressive episodes. Intravenous ketamine is advantageous for post-operative analgesia and is associated with a reduction in total opioid requirements. Few studies have treated chronic pain or concurrent depression and pain with ketamine. Larger, randomized control trials are needed to examine the safety and efficacy of intravenous vs. intranasal ketamine, ideal target populations, and optimal dosing to treat both depression and pain.
AB - Ketamine is an anesthetic drug which is now used to treat chronic pain conditions and psychiatric disorders, especially depression. It is an N-methyl-D-aspartate (NMDA) receptor antagonist with additional effects on α-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, hyperpolarization-activated cyclic nucleotide-gated (HCN) channels, opioid receptors, and monoaminergic receptors. This article focuses on ketamine's role in treating depression and pain, two commonly comorbid challenging conditions with potentially shared neurobiologic circuitry. Many clinical trials have utilized intravenous or intranasal ketamine for treating depression and pain. Intravenous ketamine is more bioavailable than intranasal ketamine and both are effective for acute depressive episodes. Intravenous ketamine is advantageous for post-operative analgesia and is associated with a reduction in total opioid requirements. Few studies have treated chronic pain or concurrent depression and pain with ketamine. Larger, randomized control trials are needed to examine the safety and efficacy of intravenous vs. intranasal ketamine, ideal target populations, and optimal dosing to treat both depression and pain.
KW - Esketamine
KW - Interventional psychiatry
KW - Ketamine
KW - Major depressive disorder
KW - Pain
UR - http://www.scopus.com/inward/record.url?scp=85123743712&partnerID=8YFLogxK
U2 - 10.1016/j.jns.2022.120152
DO - 10.1016/j.jns.2022.120152
M3 - Article
C2 - 35092901
AN - SCOPUS:85123743712
SN - 0022-510X
VL - 434
JO - Journal of the Neurological Sciences
JF - Journal of the Neurological Sciences
M1 - 120152
ER -