Clinical use of ketamine in psychiatric disorders

Abstract

Clinical use of ketamine in psychiatric disorders has been highlighted in the past twenty years. Ketamine, an antagonist of the N-methyl-D-aspartate receptor, has been widely studied in clinical studies mostly regarding depression disorder. Here, we performed an electronic search in major indexing databases and reviewed 83 randomized controlled trials (RCTs) of ketamine in different psychiatric disorders including major depressive disorder, treatment-resistant depression, post-partum depression, bipolar depression, post-traumatic stress disorder, obsessive compulsive disorder, generalized anxiety disorder, social anxiety disorder and autism spectrum disorder. The results also included recent reports on the use of esketamine in major depressive disorder in addition to studies related to the anti-depressant effect of ketamine in suicidal ideation and in combination with electroconvulsive therapy. There has been some concerns and limitations regarding the use of ketamine in most of the studies ketamine was used as add-on therapy; optimum dosage, profile of cognitive effect and side effects are yet to be determined. Moreover, large-scale RCTs and data concerning acute depression are still lacking. Altogether, prescription of ketamine for depression disorder is increasing in the light of available clinical findings, yet more trials are needed to evaluate the efficacy, safety and tolerability of ketamine and esketamine in the treatment of other psychiatric disorders.