Back to Search
Start Over
Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation.
- Source :
-
The American journal of psychiatry [Am J Psychiatry] 2021 May 01; Vol. 178 (5), pp. 383-399. Date of Electronic Publication: 2021 Mar 17. - Publication Year :
- 2021
-
Abstract
- Replicated international studies have underscored the human and societal costs associated with major depressive disorder. Despite the proven efficacy of monoamine-based antidepressants in major depression, the majority of treated individuals fail to achieve full syndromal and functional recovery with the index and subsequent pharmacological treatments. Ketamine and esketamine represent pharmacologically novel treatment avenues for adults with treatment-resistant depression. In addition to providing hope to affected persons, these agents represent the first non-monoaminergic agents with proven rapid-onset efficacy in major depressive disorder. Nevertheless, concerns remain about the safety and tolerability of ketamine and esketamine in mood disorders. Moreover, there is uncertainty about the appropriate position of these agents in treatment algorithms, their comparative effectiveness, and the appropriate setting, infrastructure, and personnel required for their competent and safe implementation. In this article, an international group of mood disorder experts provides a synthesis of the literature with respect to the efficacy, safety, and tolerability of ketamine and esketamine in adults with treatment-resistant depression. The authors also provide guidance for the implementation of these agents in clinical practice, with particular attention to practice parameters at point of care. Areas of consensus and future research vistas are discussed.
- Subjects :
- Delivery of Health Care
Depressive Disorder, Major psychology
Depressive Disorder, Treatment-Resistant psychology
Dissociative Disorders chemically induced
Humans
Hypertension chemically induced
Implementation Science
Lower Urinary Tract Symptoms chemically induced
Monitoring, Physiologic
Patient Selection
Personnel Staffing and Scheduling
Psychoses, Substance-Induced etiology
Substance-Related Disorders
Suicidal Ideation
Antidepressive Agents therapeutic use
Depressive Disorder, Major drug therapy
Depressive Disorder, Treatment-Resistant drug therapy
Excitatory Amino Acid Antagonists therapeutic use
Ketamine therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1535-7228
- Volume :
- 178
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- The American journal of psychiatry
- Publication Type :
- Academic Journal
- Accession number :
- 33726522
- Full Text :
- https://doi.org/10.1176/appi.ajp.2020.20081251