Ketamine and Esketamine in Treatment of Resistant Depression
Archiv Euromedica December 26, 2024 Jakub Prosowski, Szczepan Pośpiech, Michał Piotrowski et al.
Ketamine and esketamine provide rapid antidepressant effects within hours for treatment-resistant depression, with symptom relief lasting days to weeks. Esketamine as an intranasal spray improves accessibility. Ketamine also quickly reduces suicidal ideation, aiding crisis management. Both drugs enhance neuroplasticity by blocking NMDA receptors, increasing glutamate release, activating AMPA receptors, and promoting synaptogenesis. They boost brain-derived neurotrophic factor and the mTOR pathway, strengthening synaptic connections in mood-regulating brain regions. Short-term effectiveness is clear, but long-term safety data are scarce. Ketamine-based therapies offer a promising alternative for patients unresponsive to conventional antidepressants.