Ketamine and esketamine for crisis management in patients with depression: Why, whom, and how?

被引:13
作者
Lengvenyte, Aiste [1 ,2 ,3 ]
Strumila, Robertas [1 ,2 ,3 ]
Olie, Emilie [1 ,2 ]
Courtet, Philippe [1 ,2 ]
机构
[1] CHU Montpellier, Dept Emergency Psychiat & Acute Care, Montpellier, France
[2] Univ Montpellier, INSERM, CNRS, IGF, Montpellier, France
[3] Vilnius Univ, Fac Med, Inst Clin Med, Psychiat Clin, Vilnius, Lithuania
关键词
Suicide; Crisis; Ketamine; Depression; Intervention; TREATMENT-RESISTANT DEPRESSION; REPEATED INTRAVENOUS KETAMINE; RAPID TREATMENT CENTER; SUICIDAL IDEATION; DOUBLE-BLIND; ANTIDEPRESSANT EFFICACY; BIPOLAR DEPRESSION; RATING-SCALE; ADJUNCTIVE KETAMINE; TREATMENT RESPONSE;
D O I
10.1016/j.euroneuro.2022.02.004
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Currently, only a limited number of interventions can rapidly relieve depressive symptoma-tology in patients with major depressive disorder or bipolar disorder experiencing extreme distress. Such crises, especially when suicide attempt or ideation is involved, are a major risk factor of suicide. Ketamine, a N-methyl-D-aspartate glutamate receptor antagonist, and its enantiomer esketamine rapidly reduce depressive symptoms in depressed patients with current suicidal ideation. Recently, esketamine has been approved for use in patients with depression at risk of suicide and for psychiatric emergency by major medical agencies in the United States and Europe, whereas ketamine is increasingly used off-label. However, there is currently lim-ited guidance on why, when, and how to use these drugs in patients with depression to treat a crisis. In this review article, we provide a succinct overview of the cellular and molecular mechanisms of action of ketamine and esketamine, and of the functional brain changes fol-lowing their administration. We also summarize the major clinical studies on ketamine and esketamine efficacy in patients experiencing a crisis (generally, suicidal ideation), and propose a profile of patients who can benefit most from such drugs, on the basis of neurobiological and clinical observations. Finally, we describe the administration mode, the efficacy and tolerability profiles, the side effect management, possible concomitant treatments and the issue of deprescribing. (C) 2022 Elsevier B.V. and ECNP. All rights reserved.
引用
收藏
页码:88 / 104
页数:17
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