Abstract
A lack of effective treatment for patients with treatment-resistant depression (TRD) has led to the evaluation of ketamine, an N-methyl- D-aspartate receptor antagonist. Despite the demonstrated short-term benefits of using intravenous (IV) ketamine, side effects and the difficulty in administering ketamine outside the health-care setting has raised interest in alternative dosage forms. Research articles evaluating oral or intranasal (IN) ketamine were retrieved from the PubMed database. Patients who received oral or IN ketamine experienced a similar reduction in depressive symptoms within 24 hours of treatment and fewer side effects compared to patients who received IV ketamine. Novel administration forms of ketamine provide an opportunity for patients with TRD to achieve remission with fewer adverse side effects. Future studies should continue to evaluate these administration strategies in the hope of promoting ketamine’s use outside health-care settings and for longer time periods.
Highlights
Depression affects over 350 million people worldwide.[1]
Two articles evaluated IN administration of ketamine, one being randomized controlled trials (RCTs) while the other is a case-series
Comparison of bipolar symptoms pre(1-2 weeks prior) and post-treatment with six 10mg doses of intranasal ketamine over a 20 week period
Summary
The current standard of care for depression is primarily pharmacologic therapies that can alter neurological function of monoaminergic receptors within the central nervous system (CNS). These include serotonin selective reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and anti-psychotics. Treatment-resistant depression (TRD) is defined as MDD that does not adequately respond to treatment after appropriate courses of time with at least two anti-depressants.[3] Inadequate response can be classified as either a complete lack of response or as the patient’s failure to achieve complete remission.[4] SSRIs and other first-line pharmaceutical treatments for depression take days or weeks to show clinical improvement, and produce an adequate response in less than two-thirds of patients.[5]
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