Emerging evidence for antidepressant actions of anesthetic agents.

Several anesthetic drugs show promise as novel antidepressants for treatment-resistant depression. Ketamine has acute, transient antidepressant and antisuicidal effects. Nitrous oxide has also shown antidepressant efficacy. Converging preclinical and clinical data indicate that isoflurane (and perhaps propofol), dosed to burst suppression, produces relatively rapid, robust, and durable antidepressant effects without the adverse cognitive effects associated with electroconvulsive therapy (ECT). Ketamine is the most well-studied among them. Anesthetic-induced burst suppression may offer an alternative to ECT. Further study is needed to understand how these drugs work and how they might be used effectively.

Study at a glance

Abstract

After decades without substantial advances, multiple novel antidepressants show promise against treatment-resistant depression. Interestingly, many of these are anesthetics. The purpose of this review is to discuss the evidence for the antidepressant effects of ketamine, nitrous oxide, isoflurane and propofol and to consider potential clinical, administrative and research implications for anesthesiologists. Ketamine has acute, transient antidepressant and antisuicidal effects. Nitrous oxide has also shown antidepressant efficacy. There are converging preclinical and clinical data that isoflurane (and perhaps propofol), dosed to burst suppression, has relatively rapid, robust and durable antidepressant effects and lacks the adverse effects associated with electroconvulsive therapy (ECT). Several anesthetics show promise as novel antidepressants. Ketamine is the most well studied. Anesthetic-induced burst-suppression may provide an alternative to ECT that lacks adverse cognitive effects. Further study is necessary to better understand how these drugs work and how they might be used as effective antidepressant therapy.