Ketamine Review: Small Section on ECT

Out on PubMed, from authors in Sweden, is this review:

Ketamine and Esketamine in Clinical Trials: FDA-Approved and Emerging Indications, Trial Trends With Putative Mechanistic Explanations.

Vekhova KA, Namiot ED, Jonsson J, Schiöth HB.Clin Pharmacol Ther. 2024 Oct 20. doi: 10.1002/cpt.3478. Online ahead of print.PMID: 39428602 Review.

The abstract is copied below:


Ketamine has a long and very eventful pharmacological history. Its enantiomer, esketamine ((S)-ketamine), was approved by the US Food and Drug Administration (FDA) and EMA for patients with treatment-resistant depression (TRD) in 2019. The number of approved indications for ketamine and esketamine continues to increase, as well as the number of clinical trials. This analysis provides a quantitative overview of the use of ketamine and its enantiomers in clinical trials during 2014-2024. A total of 363 trials were manually assessed from clinicaltrial.gov with the search term "Ketamine." The highest number of trials were found for the FDA-approved indications: anesthesia (~22%) and pain management (~28%) for ketamine and TRD for esketamine (~29%). Clinical trials on TRD for both ketamine and esketamine also comprised a large proportion of these trials, and interestingly, have reached phase III and phase IV status. Combinatorial treatment of psychiatric disorders and non-psychiatric conditions with pharmacological and non-pharmacological combinations (electroconvulsive therapy, psychotherapeutic techniques, virtual reality, and transcranial magnetic stimulation) is prevalent. Sub-anesthetic doses of ketamine may represent novel therapeutic avenues in neuropsychiatric conditions, that is, major depression, schizophrenia, and bipolar disorder, where glutamate excitotoxicity and oxidative stress are likely to be involved. The study suggests that the number of ketamine studies will continue to grow and possible ketamine variants can be approved for treatment of additional indications.


The article is here.

And from the text:



Here's a review touting a brave new world of multiple uses for ketamine and esketamine.
Figure 3, above, shows the disparate clinical entities for which ketamine is being trialled; not sure why depression is considered separately from "psychiatric disorders."
The ECT section reviews some of the studies about ketamine's pros and cons as an induction agent in ECT.

(PS: Recent news stories about ketamine turning up on the street in "pink cocaine" paint a less rosy picture...)


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