Treatment Of Depression In Patients Research Articles

[Effects of a Motivational Intervention on the Effectiveness and Sustainability of Sports and Exercise Therapy in Inpatient Psychiatric Care].

Reinforcement and sustainability of sports and exercise therapy in inpatient depression treatment. Randomized controlled study with 3 measurement times: t0 admission to the study, t1 after four weeks, t2 two months after discharge. 96 inpatients with depressive disorders (ICD-10 F32, F33) were randomly assigned to an intervention group (IG) or a control group (KG). In addition to sports and exercise therapy (KG), the IG received an educational and motivational session on the importance of sports and exercise, as well as a motivational final discussion. Endurance performance and physical fitness improved more significantly in the IG than in the CG over the 3 measurement times. The motivational final discussion was rated as more helpful. The intervention was well accepted by the patients and partially increased the effects of sports and exercise therapy. Not only psychological aspects of depression treatment were influenced, but also measurable physical effects. The practical and time-efficient motivational intervention in inpatient psychiatric care can complement sports and exercise therapy for depressive patients.

The Treatment of Depression in Patients with Heart Failure

The Treatment of Depression in Patients with Heart Failure

Non-pharmacological interventions for depression in patients with heart failure: a systematic review

Non-pharmacological interventions for depression in patients with heart failure: a systematic review

Impact of virtual reality-based therapy on post-stroke depression: A systematic review and meta-analysis of randomized controlled trials.

Post-stroke depression is the most common neuropsychiatric consequence and reduces rehabilitation effectiveness. However, the efficacy of virtual reality (VR) on mental health treatment for patients after a stroke is uncertain. The aim of this study was to evaluate the efficacy of VR as a co-adjuvant form of treatment to reduce depression in stroke patients admitted to neurorehabilitation units. We systematically searched medical databases including PubMed, CINAHL, PsycINFO, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov from inception to November 16, 2023. Clinical trials comparing the use of VR as an adjuvant form of treatment in stroke patients' rehabilitation with the usual treatment were included. Pooled standardized mean differences were calculated using a random-effects model. Subgroup analyses were performed according to type of stroke, VR characteristics, and the scale used to measure depression. Meta-regression analysis was performed for intervention duration and to determine the mean age of the participants. Eight studies and 388 stroke patients were included. The VR interventions were associated with a lower risk of depression in patients (ES = -0.69; 95% CI [-1.05, -0.33]; I2 = 57.6%; p ≤ .02). The estimates were not affected by the type of stroke, the type of VR used, the blinding process, the type of scale used to detect depression, the duration of the intervention (weeks and minutes), and the total number of sessions. Meta-regression shows that younger samples (p = .00; 95% CI [0.01, 0.08) and longer interventions (p = < .05; 95% CI [-0.00, -0.00) lead to a greater reduction in depression. This review provides an important basis for treating depression in patients after a stroke. Professionals working in stroke neurorehabilitation units should consider VR as a form of co-adjuvant treatment for depression in patients. CRD42022303968.

Economic Evaluation of a Web Application Implemented in Primary Care for the Treatment of Depression in Patients with Type 2 Diabetes Mellitus: A Multicenter Randomized Clinical Trial (Preprint)

Economic Evaluation of a Web Application Implemented in Primary Care for the Treatment of Depression in Patients with Type 2 Diabetes Mellitus: A Multicenter Randomized Clinical Trial (Preprint)

Response to ketamine treatment for major depressive disorder not associated with number of psychiatric comorbidities

BackgroundKetamine has demonstrated efficacy in treating depression unresponsive to traditional interventions and is increasingly utilized in psychiatric practice. However, limited information is available regarding effectiveness in patients with psychiatric comorbidity. The aim of this study is to compare the response of ketamine treatment for depression in patients in a community sample with and without one or more coexisting psychiatric diagnoses. MethodsA retrospective review of medical records from a community ketamine clinic was done. Statistical analyses compared response to intravenous ketamine treatment, as defined by a 50% reduction in Patient Health Questionnaire (PHQ-9) score or final score of <10, in patients with an isolated diagnosis of major depressive disorder (MDD) to those with comorbid generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and/or attention-deficit/hyperactivity disorder (ADHD). ResultsData from 129 patient were analyzed (55.8 % female). It was found that the number of psychiatric comorbidities was not associated with ketamine treatment response rate nor mean change in PHQ-9 scores. LimitationsLevel of previous treatment resistance was not assessed systematically, and psychiatric interview and some elements of the patients’ care were not standardized, such as treatment schedule and dosing. ConclusionsThese findings suggest ketamine may be an effective treatment for depression in appropriate patients with psychiatric comorbidities including GAD, OCD, PTSD and/or ADHD. Additional investigation is warranted to evaluate various patient-level and other factors that may impact ketamine's ability to attenuate depressive symptoms.

Discontinuation strategies and long-term outcome of antidepressant medications

In terms of the treatment of depression, it is proven by many research that antidepressant drug has a significant impact on the treatment of depression patients. They can make them feel better and cope with their challenges. However, discontinuing these medications can be challenging due to concerns such as relapse, withdrawal symptoms, recurrence, and patient preferences. In this paper, we conducted a review of research on strategies for stopping antidepressants. Explored their long-term effects. By analyzing randomized controlled trials, cohort studies, systematic reviews, and meta-analyses, we gained insights into discontinuation methods and the extended impact of antidepressant use. Findings from quality evidence suggest that abruptly stopping antidepressants increases the risk of relapse or recurrence compared to reducing dosage or continuing with medication. Similarly, reducing dosage gradually helps in decreasing the risk and severity of withdrawal symptoms when compared to discontinuation or continued use without tapering off. Furthermore, psychological interventions like therapy or mindfulness-based cognitive therapy are identified as a best protocol for preventing relapse or recurrence after discontinuing antidepressants. These interventions are found to be particularly effective for patients experiencing symptoms or having risk factors. Additionally, although there is evidence regarding the long-term outcomes of using antidepressants beyond two years, some studies suggest that additional interventions such as patient education, shared decision-making processes monitoring progress, and providing feedback can assist in supporting successful discontinuation by improving adherence and patient satisfaction. In summary, stopping antidepressant medication is a process that necessitates assessment.

Depression-like phenotypes in mice with hepatic ischemia/reperfusion injury: A role of gut–microbiota–liver–brain axis via vagus nerve

Depression is a frequent symptom in patients with chronic liver disease; however, the mechanisms underlying this association remain unclear. Dysbiosis of gut microbiota plays a critical role in depression through the gut–brain axis via the vagus nerve. In this study, we investigated whether the gut–microbiota–liver–brain axis plays a role in depression-like phenotypes in mice with hepatic ischemia/reperfusion (HI/R) injury via the vagus nerve. Behavioral tests for depression-like behaviors were performed 7 days after sham or HI/R injury surgery. Mice with HI/R injury exhibited splenomegaly, systemic inflammation, depression-like behaviors, reduced expression of synaptic proteins in the prefrontal cortex (PFC), abnormal composition of gut microbiota, and altered blood metabolites and lipids. Furthermore, there were positive or negative correlations between the relative abundance of microbiome and behavioral data or blood metabolites (or lipids). Moreover, subdiaphragmatic vagotomy significantly blocked these changes in mice with HI/R injury. Notably, depression-like phenotypes in mice with HI/R injury were ameliorated after subsequent single injection of the new antidepressant arketamine. The current findings suggest that HI/R injury induces depression-like phenotypes in mice through the gut–microbiota–liver–brain axis via the subdiaphragmatic vagus nerve. Furthermore, arketamine may have therapeutic potential in the treatment of depression in patients with chronic liver disease.

Psychotherapeutic inpatient depression treatment in open versus closed group format.

Objective: Controversy exists about the comparative efficacy of different group formats, e. g., open versus closed. Most of the findings come from outpatient, closed group research. In practice, the open format is more widely used. This monocentric study aims to compare the efficacy as well as group cohesion during inpatient group psychotherapy for depression delivered in an open versus closed format. Methods: 291 depressed inpatients (ageM= 55.7, SD = 11) of a psychosomatic-rehabilitation clinic were consecutively assigned to either open (n = 117) or closed (n = 174) cognitive-behavioral groups, further subdivided into groups based on length of the stay. Using multilevel models, we examined depression and group cohesion concerning changes in patients' random effects over time. Results: Both group formats showed a reduction in symptomatology (d = 1.8). A significant group format x time interaction in favor of the closed format was found regarding group cohesion. Conclusion: While group cohesion improved in the closed format only, we did not find any significant difference between group formats regarding their efficacy. Further research should focus on randomized controlled trials comparing both formats directly.

Impact of COVID-19 on the treatment of depressive patients in Germany-a gap in care for the mentally ill?

The COVID-19 pandemic led to a higher incidence of depression and a worsening of psychiatric conditions, while pre-existing constraints of the healthcare system and safety regulations limited psychiatric care. We investigated the impact of the pandemic on the clinical care of patients with a single episode (SE-MDD) or major depressive disorder (MDD) in Germany. Nationwide inpatient data were extracted from the German Institute for Hospital Remuneration System for 2020 and 2021 (depression data) and the Robert Koch Institute (COVID-19 incidence). Changes in inpatients were tested with linear regression models. Local cases of depression in our department compared to 2019 were explored with one-way ANOVA and Dunnett's test. Across Germany, the inpatient numbers with both SE-MDD and MDD declined by more than 50% during three out of four COVID-19 waves. Higher COVID-19 incidence correlated with decreased inpatient numbers. In our department, fewer MDD inpatients were treated in 2020 (adj. p < 0.001) and 2021 (adj. p < 0.001) compared to 2019, while the number of SE-MDD inpatients remained stable. During this period fewer elective and more emergency inpatients were admitted. In parallel, MDD outpatient admissions increased in 2021 compared to 2019 (adj. p = 0.002) and 2020 (adj. p = 0.003). During high COVID-19 infection rates, MDD patients received less inpatient care, which might cause poor outcomes in the near future. These data highlight the necessity for improved infrastructure in the in- and outpatient domains to facilitate accessibility to adequate care.

Step away from depression-results from a multicenter randomized clinical trial with a pedometer intervention during and after inpatient treatment of depression.

Evidence for the effectiveness of physical activity (PA) in the treatment of depression prevails for outpatients with mild and moderate symptom levels. For inpatient treatment of severe depression, evidence-based effectiveness exists only for structured and supervised group PA interventions. The Step Away from Depression (SAD) study investigated the effectiveness of an individual pedometer intervention (PI) combined with an activity diary added to inpatient treatment as usual (TAU). In this multicenter randomized controlled trial, 192 patients were randomized to TAU or TAU plus PI. The two primary outcomes at discharge were depression-blindly rated with the Montgomery-Åsberg Depression Rating Scale (MADRS)-and average number of daily steps measured by accelerometers. Secondary outcomes were self-rated depression and PA, anxiety, remission and response rates. Multivariate analysis of variance (MANOVA) revealed no significant difference between both groups for depression and daily steps. Mean MADRS scores at baseline were 29.5 (SD = 8.3) for PI + TAU and 28.8 (SD = 8.1) for TAU and 16.4 (SD = 10.3) and 17.2 (SD = 9.9) at discharge, respectively. Daily steps rose from 6285 (SD = 2321) for PI + TAU and 6182 (SD = 2290) for TAU to 7248 (SD = 2939) and 7325 (SD = 3357). No differences emerged between groups in secondary outcomes. For severely depressed inpatients, a PI without supervision or further psychological interventions is not effective. Monitoring, social reinforcement and motivational strategies should be incorporated in PA interventions for this population to reach effectiveness.

No benefit of antidepressants in inpatient treatment of depression. A longitudinal, quasi-experimental field study

RationaleAntidepressants (AD) are mostly considered indispensable for the treatment of major depression. The vast majority of depressive inpatients are treated with AD. However, there is a growing body of studies indicating that the effectiveness of AD is greatly overestimated due to methodological issues with the AD efficacy studies (e.g., publication bias, unintentional unblinding, confusion between withdrawal symptoms and relapse).ObjectivesThe benefit of the additional use of AD in the inpatient treatment of depression with intensive cognitive-behavioral therapy (CBT) has been investigated in a naturalistic design.MethodsDepressiveness was assessed using the Beck Depression Inventory (BDI-II) during a preliminary interview (T0), at admission (T1), at discharge (T2), and at a 6-month follow-up (T3). Two study phases were compared: During Phase A, AD were recommended in accordance with the German guideline. In Phase B, AD were no longer recommended, and they were only prescribed upon explicit request from patients. In phase A (N = 574), 60.3% of all patients were taking AD at discharge. In Phase B (N = 424), 27.9% of patients were on AD at discharge. Apart from the difference in AD usage, the two treatment conditions were similar, and the samples did not significantly differ in terms of age, sex, diagnoses, history of suicide attempts, comorbid anxiety disorders, and unemployment.ResultsIn both study phases, BDI-II scores were strongly decreased at T2 and T3, respectively, compared with T1. The BDI-II scores of the two phases did not differ at any of the measurement time points. Depression changes were similar in both phases. In sequential multiple regression analyses with the total sample, AD were no significant predictors for the reduction of depression at either T2 or T3.ConclusionsThe inpatient CBT was effective in depression. The effectiveness of CBT is not improved by the additional use of AD. The current prescribing practices of AD should be questioned.

Better than we think: Is the treatment of depressed patients more effective than we think?

Most studies of depression treatment rely on measures of symptom severity to evaluate outcome. We hypothesized that many patients would consider themselves to have benefitted significantly from treatment despite not being considered a responder according to a measure of depression symptom severity (ie, 50% reduction in symptom score). In our study, 854 patients with major depressive disorder completed the Remission from Depression Questionnaire, a self-report measure that assesses several constructs patients consider to be relevant for assessing treatment outcome. At discharge, patients completed the Patient Global Rating of Improvement (PGI) to gauge effectiveness of treatment. Less than 40% of patients were responders on the depressive symptom subscale, whereas two-thirds of the sample were PGI responders. Among patients who were PGI responders but nonresponders on the depression symptoms scale, more than one-half were responders on at least 1 of 4 nonsymptom domains (functioning, quality of life, coping ability, positive mental health). A patient-centered approach to evaluating outcome goes beyond an assessment of symptoms. When viewed from a broader perspective, the results of our study suggest that patients with depression benefit more from treatment than is suggested by only examining outcome from a symptom-based perspective.

Mechanisms of change in digital cognitive behavioral therapy for depression in patients with chronic back pain: A mediation analysis of a multicenter randomized clinical trial

BackgroundWhile there is evolving knowledge on change processes of digital cognitive behavioral therapy (CBT) in the treatment of depression, little is known about how these interventions produce therapeutic change in the comorbid constellation of chronic back pain (CBP). Here, we examined whether the effects of a digital intervention to treat depression in patients with CBP are mediated by three pain-related variables (i.e., pain self-efficacy, pain-related disability, pain intensity). MethodsThis study is a secondary analysis of a randomized clinical trial conducted in routine care at 82 orthopedic clinics across Germany. In total, 209 adults with CBP and diagnosed depression (SCID interview) were randomly assigned to the intervention (n = 104) or treatment-as-usual (n = 105). Cross-lagged mediation models were estimated to investigate longitudinal mediation effects of putative mediators with depression symptom severity (PHQ-9) as primary outcome at post-treatment. ResultsLongitudinal mediation effects were observed for pain self-efficacy (ß = −0.094, 95%-CI [−0.174, −0.014], p = 0.021) and pain-related disability (ß = −0.068, 95%-CI [−0.130, −0.001], p = 0.047). Furthermore, the hypothesized direction of the mediation effects was supported, reversed causation did not occur. Pain intensity did not reveal a mediation effect. ConclusionsThe results suggest a relevant role of pain self-efficacy and pain-related disability as change processes in the treatment of depression for patients with CBP in routine care. However, further research is needed to disclose potential reciprocal relationships of mediators, and to extend and specify our knowledge of the mechanisms of change in digital CBT for depression.

Effect of Home-based Self-administered Transcranial Direct Stimulation in Patients with Mild to Moderate Major Depressive Disorder: A Single-arm, Multicentral Trial

Although the effects and safety of transcranial direct current stimulation (tDCS) treatment in depressive patients are largely investigated, whether the self-administration of tDCS treatment at patient's home is comparable to clinic-based treatment is still unknown. In this single-arm, multi-center clinical trial, 61 patients with mild to moderate major depressive disorder were enrolled. tDCS treatment was delivered at the patient's home once a day, 5 to 7 times a week for 6 weeks, and each session lasted for 30 minutes. The primary outcome was a total Beck-Depression Inventory-II score, and no concurrent antidepressants were used. The remission rates in both Full-Analysis (FA) (n = 61) and Per-Protocol (PP) (n = 43) groups were statistically significant (FA: 57.4% [0.44-0.70], PP: 62.8% [0.47-0.77]; percent [95% confidence interval]). The degree of depression- related symptoms was also significantly improved in 2, 4, and 6 weeks after the treatment when compared with baseline. There was no significant association between treatment compliance and remission rate in both FA and PP groups. These results suggest that acute treatment of patient-administered tDCS might be effective in improving the subjective feeling of depressive symptoms in mild to moderate major depressive disorder patients.

New Perspectives on Treatment of Depression in Coronary Heart Disease.

It has been 35 years since we published a study in Psychosomatic Medicine showing that patients with coronary heart disease (CHD) and major depression were at twice the risk of having a cardiac event as were nondepressed patients (Carney et al. Psychosom Med. 1988;50:627-33). This small study was followed a few years later by a larger, more convincing report from Frasure-Smith et al. (JAMA. 1993;270:1819-25) showing that depression increased the rate of mortality in patients with a recent acute myocardial infarction. Since the 1990s, there have been many more studies of depression as a risk factor for cardiac events and cardiac-related mortality from all over the world, and many clinical trials designed to determine whether treating depression improves medical outcomes in these patients. Unfortunately, the effects of depression treatment in patients with CHD remain unclear. This article considers why it has been difficult to determine whether treatment of depression improves survival in these patients. It also proposes several lines of research to address this question, with the goal of definitively establishing whether treating depression can extend cardiac event-free survival and enhance quality of life in patients with CHD.

RTMS ameliorates depression/anxiety-like behaviors in experimental autoimmune encephalitis by inhibiting neurotoxic reactive astrocytes

One third of patients with multiple sclerosis (MS) suffered from depressive symptoms. The pathogenesis of depression in MS patients has been related to innate immune activation in certain regions of the brain such as hippocampus. However, pharmacotherapy lacks sufficient evidence for beneficial effects on depression in MS patients, urging for a novel treatment modality for this mental disorder. Treatment effects of rTMS on depression/anxiety-like behaviors in mice with experimental autoimmune encephalomyelitis (EAE) were assessed by behavioral tests. The role of innate immune response was examined by RNA sequencing, quantitative RT-PCR, and immunofluorescence techniques. Depressive symptom severity and astroglial activation in patients with MS were assessed by Beck Depression Inventory and serum glial fibrillary acidic protein (GFAP), respectively. EAE mice displayed depression/anxiety-like behaviors, which were ameliorated by rTMS. Transcriptome and gene-specific expression analysis of the hippocampus showed significant reduction in transcript levels associated with neurotoxic reactive astrocytes in EAE mice after rTMS treatment. This was confirmed by immunofluorescence studies. Complement component 3d, a marker of neurotoxic reactive astrocytes, was highly expressed in EAE hippocampus, but was reduced to a basal level after rTMS treatment. In patients with MS, astroglial activation, indicated by serum GFAP levels, was significantly elevated in those with moderate or major depressive symptoms. These findings support that the suppression of neurotoxic reactive astrocytes might be a potential target for treatment of depression in patients with MS, and suggest the potential of using rTMS as a potential therapeutic treatment for this disorder.

A non-randomized, controlled, interventional study to investigate the effects of community pharmacists’ cognitive behavioral therapy–based interventions on medication adherence and relevant indicators in patients with depression

BackgroundThe prevalence of depression is increasing in Japan. Pharmacists play an important role in helping patients use medicines effectively. Several studies had investigated the impact of community pharmacists on patient adherence to antidepressant therapy, and their results indicated that further study was warranted.MethodsThis study was conducted from June 2019 to May 2020 using a cluster non-randomized, open-label, parallel-group design. Four community pharmacy stores in Osaka and Hyogo Prefectures, Japan, participated in the study, and enrolled patients with unipolar depression. In the intervention group (IG), patients received cognitive behavioral therapy (CBT)-based medication support, and their medication adherence and adverse drug reactions were monitored by telephone. In the control group (CG), the pharmacists engaged in routine interactions with the study participants. Before participating in this study, the intervention-group pharmacists attended a 5-hour training session on CBT-based medication support. The primary outcome of this study was medication adherence, assessed using the Drug Attitude Inventory (DAI)-10. Secondary outcomes included the changes from baseline at 6 months in the following variables: the Patient Health Questionnaire (PHQ)-9 total score, the EQ-5D-5 L (Euro-QOL 5 dimensions 5 levels) score, patient satisfaction, and the Pharmacists’ Confidence Scale about Medication Consultation for Depressive Patients (PCMCD) score.ResultsFour pharmacies (two in IG and two in CG) completed the intervention period. Results were obtained from 19 patients in the IG and 12 patients in the CG. In the IG, the mean DAI-10 score increased from 4.941 at baseline to 6.105, the mean PHQ-9 score decreased from 9.263 to 8.625, and the mean patient satisfaction score increased from 39.947 to 42.211. In the CG, the mean DAI-10 score decreased from 6.333 to 4.167, the mean PHQ-9 score increased from 9.333 to 12.923, and the mean patient satisfaction score decreased from 38.929 to 38.167.ConclusionCBT-based medication support provided by community pharmacists may improve patient medication adherence to antidepressant therapy and symptoms. Such support can be expected to facilitate better treatment of depressed patients and may also allow the duration of treatment to be shortened.Trial registrationUMIN000037954, Date of first registration: 17/06/2019.

Depression in Saudi Patients with Rheumatoid Arthritis.

Depression is the most common psychiatric disorder associated with rheumatoid arthritis (RA). However, little is known about its prevalence and risk factors among Saudi patients, specifically. Therefore, this study sought to determine the prevalence and predictors of depression in patients with RA in Saudi Arabia. A cross-sectional study was conducted with patients registered at the Saudi Charitable Association for Rheumatic Diseases. Inclusion criteria were that the patients either met the American College of Rheumatology 1987 revised criteria for the classification of RA or the 2010 RA classification criteria. Demographic data and clinical variables were collected, and Beck's 21-item Depression Inventory was used to assess for depression. Of the 210 participants with RA, 171 were women (81.4%), and 39 were men (18.6%). The prevalence of depression was 68%. There were significant relationships between age, gender, marital status, and having depression. Rheumatoid factor (RF) was positive in 144 participants (68.6%), which positively correlated with the risk of having depression (P value < 0.001). Moreover, depression severity correlated with age, gender, marital status, RF positivity, and prolonged disease duration. Based on the results, depression is highly prevalent in Saudi patients with RA, especially those with positive RF and those who are female, middle-aged, and divorced. Early detection and treatment of depression in patients with RA is highly recommended to improve their quality of life and avoid unfavorable effects on RA clinical progression.

The role of ketamine as an antidepressant agent

Depression is a common mental health condition that affects millions of people worldwide.[1,2] Whereas traditional antidepressant medications have been effective for many individuals, a significant number of patients continue to struggle with depression even after trying multiple treatments. It is estimated that up to one-third of individuals with depression do not respond to traditional treatments such as antidepressant medication and psychotherapy,[3,4] which has led researchers to investigate alternative treatments. Ketamine, a dissociative anesthetic and a popular recreational drug, has gained significant attention in recent years as a potential treatment for depression.[5,6] Whereas traditional antidepressants such as selective serotonin reuptake inhibitors (SSRIs) have been the first line of treatment for depression for decades, ketamine offers a new approach to managing the condition. This article will explore how ketamine works as a treatment for depression, along with its potential benefits and drawbacks. How ketamine works as a treatment for depression The exact mechanism by which ketamine works as an antidepressant is not fully understood.[7,8] However, it is thought to work by increasing the levels of certain neurotransmitters in the brain, such as glutamate[9] and serotonin.[8] Glutamate is an excitatory neurotransmitter that plays a role in learning and memory. Studies have shown that individuals with depression have reduced levels of glutamate in certain areas of the brain, such as the prefrontal cortex. Ketamine has been shown to increase glutamate levels in the brain,[9,10] which may help to improve mood. Serotonin is another neurotransmitter that is involved in regulating mood. SSRIs are commonly used to treat depression by increasing the availability of serotonin in the brain. Ketamine has also been shown to increase serotonin levels,[11] which may contribute to its antidepressant effects. In addition to its effects on neurotransmitters, ketamine may also have a direct effect on the brain’s neural pathways.[12] It has been shown to increase the growth of new connections between neurons, which may help to improve mood[13] and maintain cognitive function.[14,15] Ketamine works differently from traditional antidepressants by targeting the glutamate system in the brain.[9] Specifically, it blocks N-methyl-D-aspartate receptors, which are involved in learning and memory processes. This blockade results in an increase in the production of brain-derived neurotrophic factor (BDNF),[16] a protein that helps promote the growth and survival of neurons in the brain. BDNF is thought to play a crucial role in the development and maintenance of neural circuits that are involved in mood regulation, which may explain how ketamine can produce rapid and long-lasting antidepressant effects. Potential benefits of ketamine for depression One of the most significant benefits of ketamine for depression is its rapid onset of action.[17] Traditional antidepressants can take weeks or even months to produce noticeable improvements in mood. This quick response time can be particularly beneficial for patients who are experiencing severe depressive symptoms and require immediate relief. In addition to its rapid onset of action, ketamine has been found to be highly effective in treating depression, particularly in cases of treatment-resistant depression.[6] Studies have shown that ketamine can improve depressive symptoms in patients who have not responded to traditional antidepressant medications.[17-19] This high efficacy rate is particularly promising for patients who have struggled with depression for an extended period and have not found relief from other treatments. Another potential benefit of ketamine for depression is its long-lasting effects.[18,20,21] Whereas the initial effects of ketamine may be short-lived, research has shown that repeated treatments can produce more sustained improvements in mood. In one study, patients who received six ketamine infusions over a 2-week period reported significant improvements in mood that lasted for several weeks after treatment.[18] Ketamine has also been found to improve suicidal ideation in patients with depression. Suicidal ideation is a significant concern for individuals with depression, and finding effective treatments to reduce suicidal thoughts and behaviors is critical. Studies have shown that ketamine can reduce suicidal ideation in patients with depression, even in cases where traditional antidepressant medications have been ineffective.[22,23] One of the advantages of ketamine for depression is its safety and tolerability profile.[24,25] When administered by a trained healthcare provider in a clinical setting, ketamine is generally safe and well-tolerated. However, like any medication, ketamine can produce side effects, including nausea, dizziness, and dissociation. These side effects are typically mild and short-lived, but it is essential to monitor patients closely during treatment. Finally, ketamine has the potential to target different neurotransmitter systems, including glutamate, GABA, and dopamine.[8,26] These neurotransmitters play a crucial role in mood regulation, and modulating these systems may contribute to ketamine’s antidepressant effects. The ability to target multiple neurotransmitter systems may make ketamine a particularly effective treatment for depression in patients who have not responded to traditional antidepressant medications. Drawbacks of ketamine for depression One of the most significant drawbacks of ketamine use in treating depression is its short-term effectiveness. Ketamine has been found to produce a rapid antidepressant effect, often within hours or days of administration. However, this effect is usually short-lived, and patients may need to undergo repeated treatments to maintain the positive effects. In some cases, patients may only experience relief for a few days to a few weeks before the depressive symptoms return. This can be frustrating for patients who are seeking long-term relief from their symptoms. Another major concern with ketamine use is the potential for abuse and addiction. Ketamine is classified as a Schedule III controlled substance by the U.S. Drug Enforcement Administration.[27] While it is less addictive than some other drugs, it still has the potential for abuse and addiction. Regular use of ketamine can lead to tolerance, dependence, and addiction, which can have significant negative consequences for the user. To address these concerns, researchers are continuing to investigate the use of ketamine for depression and are exploring alternative delivery methods and dosing strategies to minimize the risk of abuse and maximize the benefits. For example, some studies investigated the use of intranasal ketamine, which can be self-administered at home and may have a lower risk of abuse than intravenous ketamine.[28-30] Other studies investigated the use of lower doses of ketamine, which may have fewer side effects and be more tolerable for patients.[17,31] In addition to the potential for abuse, ketamine use can also cause side effects. Common side effects of ketamine use include dissociation, hallucinations, and changes in perception, which can be unsettling for some patients. There may also be other side effects such as dizziness, nausea, and vomiting. Whereas these side effects are usually temporary and subside once the drug wears off, they can be distressing and may make some patients reluctant to continue with ketamine treatment. Another drawback of ketamine use is the lack of long-term data on its safety and efficacy. Whereas the drug has been studied in several clinical trials, there is still limited research on its long-term effects, particularly in terms of its safety and efficacy over longer periods.[32,33] This lack of data makes it difficult to assess the risks and benefits of ketamine treatment accurately. Finally, the cost of ketamine treatment for depression can be a significant drawback. Ketamine treatment is still considered an off-label use, meaning that insurance coverage may be limited or not available. This can make it difficult for some patients to access this treatment, particularly those who cannot afford to pay for it out of pocket. Conclusion Ketamine represents a new approach to treating depression that offers several potential benefits over traditional antidepressants, including rapid onset and long-lasting effects. However, concerns about abuse potential, dissociative effects, and long-term safety data still need to be addressed. Overall, ketamine is an exciting development in the treatment of depression, and ongoing research is needed to fully understand its potential benefits and drawbacks. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.