The use of Ketamine in Psychiatry

The use of Ketamine in Psychiatry

Short Background

Ketamine is a high-affinity receptor antagonist made up of non-competitive N-methyl-D-aspartate (NMDA)-glutamate. Ketamine is largely used as both a veterinary and human medicine for its analgesic and anesthetic properties. The behavioral and cellular responses are triggered by the NMDA receptors as ketamine blocks the pathways of neuronal communication. Ketamine is lipid- and water-soluble and appears in various forms, including IV, IM, topical, and oral (Krystal et al., 2019). A few minutes after the infusion of IV into the body, the plasma concentrations rise to the highest levels. The process takes about thirty minutes in case of oral ingestion, and fifteen minutes upon IM administration. The medicine begins to react after 6 hours when administered orally and takes about 2 hours when infused in IM form. Krystal et al. (2019) observed that the elimination of metabolites in the urine is a sign of ketamine reaction.

When ketamine is used along with antidepressant drugs and stimulants, some unwanted effects can be induced, including increased blood pressure. In some instances, visual and auditory hallucinations can be noted occasionally, particularly among the patients with alcohol dependence and those receiving high dosage (Krystal et al., 2019). Adverse effects are also felt at the injection site, especially pain, cardiac arrhythmia, tachycardia, and hypertension. The glutamatergic system of ketamine has been used for treatment-resistant depression.

Successful Clinical Researches and Future Research for use of Ketamine

Numerous clinical studies have been carried out to establish the effectiveness of the use of ketamine in treating depression and other psychiatric problems. The study by Krystal et al. (2019) investigated the glutamate system as a potential antidepressant treatment drug. The patients with treatment-resistant depression (TRD) were found to have experienced acute efficacy and safety upon the administration of intravenous ketamine (a single subanaesthetic dose). The study conducted by Messer et al. (2017) explored the effects of multiple treatments of two subjects with treatment-resistant depression using ketamine for 12 days. The researchers observed changes in the manifestation of depression symptoms in both patients in response to the treatment administered, which incorporated ketamine medicine. One of the patients reached a score of BDI˃18 in the manifest of depression symptoms within 29 days of the clinical trial. There were no problems with concentration, difficulties with memory, and cognitive impairment associated with the infusions of ketamine.

Although research has established that ketamine is effective in treating psychiatric problems, it is essential to note that many facets remain unclear about the intervention since research is still at the infancy levels. Future research needs to find out the effects of long-term use of the ketamine in controlled situations. Most of the studies have investigated the use of the drug in a correlational manner among drug abusers and drawn a generalization with respect to the human population (Su et al., 2017). One of the primary questions that should guide future studies on the use of ketamine is whether the intervention can lead to the development of full-blown psychosis. More importantly, the research should focus on establishing whether the results of the ketamine treatment among young patients can be translated to other patients who are considered more vulnerable depressed, such as the elderly. The aspect of neurotoxicity should also be explored insightfully to avoid adverse reactions.

References

Krystal, J. H., Abdallah, C. G., Sanacora, G., Charney, D. S., & Duman, R. S. (2019). Ketamine: a paradigm shift for depression research and treatment. Neuron, 101(5), 774-778.

Messer, M., Haller, I. V., Larson, P., Pattison-Crisostomo, J., & Gessert, C. E. (2017). The use of a series of ketamine infusions in two patients with treatment-resistant depression. The Journal of neuropsychiatry and clinical neurosciences, 22(4), 442-444.

Su, T. P., Chen, M. H., Li, C. T., Lin, W. C., Hong, C. J., Gueorguieva, R., … & Krystal, J. H. (2017). Dose-related effects of adjunctive ketamine in Taiwanese patients with treatment-resistant depression. Neuropsychopharmacology, 42(13), 2482-2492.