Psychiatria Danubina, Vol. 32 No. 3-4, 2020.
Review article
https://doi.org/10.24869/psyd.2020.325
THERAPEUTIC MECHANISMS OF KETAMINE
Slobodan Mihaljević
; Department of Anaesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Matko Pavlović
; Department of Psychiatry, General Hospital Bjelovar, Bjelovar, Croatia
Krešimir Reiner
; Department of Anesthesiology and Intensive Care Medicine, Clinic for Obstetrics and Gynecology, University Clinical Hospital Centre Zagreb, Zagreb, Croatia
Marko Ćaćić
Abstract
Major depressive disorder is the greatest burden of developed countries in the context of morbidity caused by mental disorders. Until recent, ketamine has been mostly used for anesthesia, analgesia, sedation and treatment of chronic pain syndromes. However, unique pharmacodynamic properties of ketamine have increased interests in it's use for treatment of depression. It is assumed that ketamine reverses synaptic chronic stress pathology within one day of administration by postsynaptic glutamate activation, providing synaptic connectivity restoration that last for days or weeks. Potential glutamatergic agents, in context of treatment of major depressive disorder are not entirely novel phenomenon. Considering the aforementioned, current neurobiological view of depression as a solely monoaminergic phenomenon should be reassessed in order to prompt discovery of putative antidepressant drugs of novel generation. Acute side effects, such as increased salivation, increase in heart rate, systemic arterial pressure and intracranial pressure necessitate careful monitoring during intravenous administration of ketamine, even in subanesthetic doses. However, major burden of ketamine administration lies in it's ability to produce psychotomimetic side effects and emergence delirium. Esketamine nasal spray has now been widely approved and is considered safe in terms of acute side effects, tolerability and consistent therapeutic benefit.
Keywords
ketamine; depression; neurobiology
Hrčak ID:
250625
URI
Publication date:
7.1.2021.
Visits: 1.661 *