Abstract
The treatment of depressive episodes remains complicated by the long latency of
antidepressant efficacy, insufficient response, and high risk of suicide.
Ketamine and esketamine have been proposed as fast-acting substances able to
overcome these impediments.
Since the first randomized controlled trial in the year 2000, numerous studies
have explored the antidepressant efficacy of ketamine and esketamine. Clear
evidence has emerged that a single infusion exerts a significant antidepressant
and antisuicidal effect in both unipolar and bipolar depression. A few studies
suggest that antidepressant response can be improved and maintained by repeated
administration. Although intravenous application has been most common,
subcutaneous, intramuscular, and intranasal application has also been
successful. There is some evidence that ketamine may accelerate the response to
electroconvulsive therapy without improving the overall response rate.
The precise position of ketamine and esketamine within treatment algorithms have
yet to be defined, and issues surrounding potential toxicity need to be
resolved.
Key words
major depression - bipolar depression - suicidality - ketamine - esketamine
