Abstract : Currently, only a
limited number of interventions can rapidly relieve depressive
symptomatology 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 limited 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 following 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.
https://hal.archives-ouvertes.fr/hal-03595001
Soumis le : jeudi 3 mars 2022
Collections UNIV-MONTPELLIER | CNRS
Citation
Aiste Lengvenyte, Robertas Strumila, Emilie Olié, Philippe Courtet. Ketamine and esketamine for crisis management in patients with depression: Why, whom, and how?. European Neuropsychopharmacology, Elsevier, 2022, 57, pp.88-104. ⟨10.1016/j.euroneuro.2022.02.004⟩. ⟨hal-03595001⟩ Facebook Twitter Email
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