Abstract
The Sri Lanka Journal of Psychiatry (SLJP) is a peer-reviewed, open access journal published bi annually by the Sri Lanka College of Psychiatrists.The Journal publishes original papers, brief reports including case reports and commentaries relevant to psychiatry and allied sciences. The Sri Lanka Journal of Psychiatry is committed to maintaining and conforming to the editorial and ethical standards recommended by the International Committee of Medical Journal Editors.The CoverCover “The perks of working as a psychiatrist in the periphery”. – Nilaveli beach early in the morning as captured by Dr Sumudu Godawita, Consultant Psychiatrist, Trincomalee.
Highlights
A significant proportion of patients with major depressive disorder are refractory to approved interventions
Ketamine reached its prominence as a safe anesthetic agent in the mid 1960’s but transitioned into a party drug when its dissociative and hallucinogenic properties were discovered by the club culture [1]
Antidepressants need significant lag time to benefit, while evidence-based psychotherapies are often difficult to access and costly [5]. This is especially true in low- and middle-income countries (LMICs)
Summary
While ketamine's antidepressant mechanisms are not fully elucidated, its predominant effect is on the glutaminergic system, where it acts as an antagonist of N-methyl-D aspartate (NMDA) receptors [9]. The intravenous route of administration is the most studied for the acute treatment of TRD, with the majority of data coming from single infusions that produced rapid antidepressant effects within hours and lasting up to a week. Such benefit has been confirmed by several metaanalyses of a significant number of RCTs [6,7,8,13]. Several small investigations have reported favourably on the use of IN racemic ketamine for maintenance after initial treatment with IV for TRD [15]. Several large RCTs and a metaanalysis confirm its superiority over placebo in the acute treatment of TRD when used as an adjunct to first line antidepressants, and is currently approved for use in the USA and Canada, though its relative high cost may discourage use in LMICs [7,13]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
