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27 - Ketamine in treatment-resistant depression

from Section 4 - Specific modalities of treatment

Published online by Cambridge University Press:  05 May 2013

By
Kyle A.B. Lapidus  and
Sanjay J. Mathew
Edited by
J. John Mann
Edited in association with
Patrick J. McGrath  and
Steven P. Roose
J. John Mann
Affiliation:
Columbia University, New York
Patrick J. McGrath
Affiliation:
Columbia University, New York
Steven P. Roose
Affiliation:
Columbia University, New York
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Summary

This chapter deals with the role of ketamine in treatment-resistant depression (TRD). Ketamine is a noncompetitive N-methyl-D-aspartate (NMDA) antagonist. Ketamine has also been reported to exert cholinergic effects, inhibiting nicotinic ACh receptor activation, while also raising ACh levels by inhibiting acetylcholinesterase. Ketamine has a chiral center at the C-2 carbon of the cyclohexanone ring, resulting in two enantiomers. Ketamine administration may include intravenous (IV), intramuscular (IM), intranasal (IN), intrarectal, epidural, subcutaneous, transdermal, intra-articular, sub-lingual, and oral routes. Repeated-dose protocols are commonly used for electroconvulsive therapy (ECT) in TRD, and ketamine has been repeatedly dosed in chronic pain conditions. The Montgomery-Asberg Depression Rating Scale (MADRS) suicide item (MADRSSI) and Beck Scale for Suicidal Ideation (SSI) were used to assess explicit suicidal ideation. Much of the available information on chronic ketamine use involves small groups of poly-drug-abusing subjects.

Keywords

yogamood disordersomega-3 fatty acidsSt. John's wortmethylatorscomplementary and alternative medicine treatmentsdepression
Type
Chapter
Information
Clinical Handbook for the Management of Mood Disorders , pp. 345 - 357
Publisher: Cambridge University Press
Print publication year: 2013

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