Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation.
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.
['McIntyre|Roger S|RS|', 'Rosenblat|Joshua D|JD|', 'Nemeroff|Charles B|CB|', 'Sanacora|Gerard|G|', 'Murrough|James W|JW|', 'Berk|Michael|M|', 'Brietzke|Elisa|E|', 'Dodd|Seetal|S|', 'Gorwood|Philip|P|', 'Ho|Roger|R|', 'Iosifescu|Dan V|DV|', 'Lopez Jaramillo|Carlos|C|', 'Kasper|Siegfried|S|', 'Kratiuk|Kevin|K|', 'Lee|Jung Goo|JG|', 'Lee|Yena|Y|', 'Lui|Leanna M W|LMW|', 'Mansur|Rodrigo B|RB|', 'Papakostas|George I|GI|', 'Subramaniapillai|Mehala|M|', 'Thase|Michael|M|', 'Vieta|Eduard|E|', 'Young|Allan H|AH|', 'Zarate|Carlos A|CA|', 'Stahl|Stephen|S|']
D000928:Antidepressive Agents D003695:Delivery of Health Care D003865:Depressive Disorder, Major D061218:Depressive Disorder, Treatment-Resistant D004213:Dissociative Disorders D018691:Excitatory Amino Acid Antagonists D006801:Humans D006973:Hypertension D000077626:Implementation Science D007649:Ketamine D059411:Lower Urinary Tract Symptoms D008991:Monitoring, Physiologic D018579:Patient Selection D010561:Personnel Staffing and Scheduling D011605:Psychoses, Substance-Induced D019966:Substance-Related Disorders D059020:Suicidal Ideation
Ketamine Esketamine Treatment-Resistant Depression Major Depressive Disorder Bipolar Disorder Suicide