Efficacy and Safety of Ketamine and Esketamine for the Treatment of Major Depressive Disorder

  • Wanida Rattanasumawong Department of Psychiatry and Neurology, Phramongkutklao Hospital
  • Pichai Ittasakul Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
Keywords: Ketamine; Esketamine; treatment resistance depression; TRD

Abstract

Background : Accumulated data have confirmed ketamine’s and Esketamine’s
antidepressant effects. On March 2019 the U.S. Food and Drug Administration (FDA)
approved esketamine nasal spray in conjunction with an oral antidepressant for
treatment resistant depression (TRD). However, as it is used in the real world, more data
will be required.
Objective : This paper will shortly review current data focused on the efficacy and
safety of Ketamine and Esketamine as a treatment for TRD.
Methods : A literature search was conducted using the following databases: MEDLINE,
Embase, PubMed, and the Cochrane Library for articles published between 2000-2019.
The search was limited to articles written in English and Thai languages, using keywords:
Ketamine, Esketamine, Arketamine, Treatment resistant depression.
Result : Ketamine and Esketamine appear to be effective treatments when combined
with oral antidepressants in patients with TRD. The special effect of esketamine is
rapid onset of antidepressant activity; a significant benefit for high-risk suicidal patients.
Esketamine, an enantiomer of ketamine, works as a more potent NMDA receptor
antagonist. Moreover, a number of studies have suggested that esketamine has lower
side effects than Ketamine. Evidence underpinning esketamine’s FDA approval (based
on 29 studies) shows greater efficacy than currently available adjunctive medications.
However, the FDA asked for 3 years follow-up from esketamine trials and implemented
a risk and benefit assessment. More adverse events were reported from esketamine
when compared with placebo, but generally most of the adverse events resolved the
same day.
Conclusion : Ketamine and Esketamine show great benefit and may be an alternative
medication for TRD. However, future study should be conducted to gather more data
to address safety, efficacy and tolerability.

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Published
2020-06-25
How to Cite
Rattanasumawong, W., & Ittasakul, P. (2020). Efficacy and Safety of Ketamine and Esketamine for the Treatment of Major Depressive Disorder. Journal of the Psychiatric Association of Thailand, 65(2), 179-190. Retrieved from https://he01.tci-thaijo.org/index.php/JPAT/article/view/243557