EClinicalMedicine
August 1, 2023
Stevan Nikolin, Anthony Rodgers, Andreas Schwaab et al.
166 citations
A systematic review and meta-analysis of 49 randomized controlled trials with 3,299 participants found that racemic ketamine produced larger reductions in depression severity than esketamine, both immediately after the first dose and during repeated dosing. Higher doses were more effective than lower doses. After the final dose, only racemic ketamine maintained a significant effect; esketamine did not. Dropout rates were similar between treatment and control conditions.
Journal of Psychoactive Drugs
November 15, 2023
Anees Bahji, Isis Lunsky, Gilmar Gutierrez et al.
21 citations
A systematic review and meta-analysis of 18 studies found that psychedelic-assisted therapies—psilocybin, LSD, MDMA, and ayahuasca—were well tolerated and produced large reductions in depression symptoms across various diagnoses. Psilocybin showed a large effect (standardized mean difference -1.92) and MDMA a moderate-to-large effect (standardized mean difference -0.71). However, the certainty of the evidence was low to very low due to small sample sizes, blinding issues, study heterogeneity, and publication bias. The results are promising but highlight the need for larger, more rigorous studies.
Psychiatry research
October 1, 2024
Gilmar Gutierrez, Jennifer Swainson, Nisha Ravindran et al.
17 citations
Both intravenous ketamine and intranasal esketamine significantly reduce depressive symptoms and suicidal ideation in people with treatment-resistant major depressive disorder. In a multi-site observational study of 53 patients, those receiving IV ketamine (26 patients, average age 52.8) and those receiving IN esketamine (27 patients, average age 43.9) showed similar improvements in depression severity and suicidal thoughts. Side effects were mild and temporary, with no significant difference in risk between the two treatments. The findings suggest both therapies are effective and well tolerated for treatment-resistant depression.
Psychiatry research
May 1, 2024
Gilmar Gutierrez, Melody J Y Kang, Gustavo Vazquez
12 citations
In patients with major depressive disorder and treatment-resistant depression, intravenous low-dose ketamine combined with standard care significantly reduced depressive symptoms and suicidal ideation over a five-year period. Of 71 outpatients, 54.93% responded to treatment, 78.26% experienced transient mild side effects, and 11.27% dropped out. Demographic variables did not affect treatment outcome or tolerability. The findings suggest that low-dose ketamine is an effective, fast-acting, and well-tolerated option for managing depressive symptoms and suicidal ideation in this population in real-world clinical settings.
Therapeutic advances in drug safety
January 1, 2025
Gilmar Gutierrez, Gustavo Vazquez, Nisha Ravindran et al.
5 citations
Intranasal esketamine, used for treatment-resistant depression, does not appear to carry significant abuse liability during an acute course of treatment. In a secondary analysis of a multicenter observational study, 23 patients with major depressive disorder reported neutral liking and no cravings for esketamine after their first dosing session, and these measures did not increase over eight sessions. Neither age, sex, baseline depression severity, side effects, nor study site influenced liking or cravings. The findings align with existing literature suggesting that acute esketamine treatment is not associated with high drug liking or cravings, though larger studies are needed.
Psychiatry research
September 1, 2026
Isis Lunsky, Gilmar Gutierrez, Xena Wang et al.
Postpartum depression (PPD) is common and harmful if untreated, with few effective prevention strategies. Ketamine and esketamine are rapid-acting antidepressants showing promise for PPD. This review searched five databases for peer-reviewed randomized controlled trials, pilot studies, and observational studies examining ketamine or esketamine for PPD prevention during pregnancy or postpartum, for both cesarean and vaginal deliveries. A network meta-analysis and narrative synthesis were used. Thirty-six studies were identified; five included vaginal delivery, thirty included cesarean section, and one did not specify delivery mode. Results suggested that ketamine and esketamine were well tolerated and may reduce PPD risk. However, data quality was low to very low, so results should be interpreted cautiously. More high-quality studies are needed.
Vertex (Buenos Aires, Argentina)
July 10, 2025
Micaela Dines, Adriana Bulacia, Paloma Bamondez et al.
Intravenous ketamine at subanesthetic doses offers rapid relief for depressive and suicidal symptoms in treatment-resistant major depression. A protocol for administering ketamine infusions in a general hospital, based on international guidelines, specifies inclusion and exclusion criteria, dosage, administration procedures, and patient monitoring. The protocol also addresses adverse effects and safety considerations, aiming to optimize ketamine's efficacy and safety for treatment-resistant depression.