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Ketamine: Its Safety, Tolerability, and Impact on Neurocognition

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Ketamine for Treatment-Resistant Depression

Abstract

Ketamine, a high-affinity, noncompetitive N-methyl-D-aspartate (NMDA) glutamate receptor antagonist, has long been used in anesthesiology and also as a drug of recreational abuse. In the last decade, the evidence has shown that a subanesthetic dose of ketamine has rapid and robust antidepressant effects in patients with treatment-resistant major depressive disorder (MDD) and bipolar depression. For the treatment of depression, the most widely used paradigm is a single 0.5 mg/kg intravenous infusion of ketamine. However, serial infusions, as well as oral and intranasal routes, have also been investigated. This chapter will discuss issues related to ketamine’s safety, tolerability, and effects on neurocognition. In patients with mood disorders, the safety and high tolerability of ketamine used intravenously at subanesthetic doses, and in low doses by other routes, has been demonstrated in many clinical studies. As a result of studies on healthy volunteers and of a ketamine model of schizophrenia (with ketamine-induced positive and negative symptoms and impaired cognition), ketamine has been perceived as a drug that exerts deleterious effects on neurocognition. However, giving ketamine in low doses to depressed patients has not been connected with a negative effect on cognition, and some studies have even shown an improvement in this respect. Possible mechanisms for this phenomenon—for example, ketamine’s ability to modify cognitive-emotional interactions in the brain—have been suggested. This chapter also discusses the issues of ketamine’s safety, tolerability, and effects on neurocognition when used as anesthesia for electroconvulsive therapy.

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Authors and Affiliations

  1. Department of Adult Psychiatry, Poznan University of Medical Sciences, ul.Szpitalna 27/33, Poznan, 60-572, Poland

    Janusz K. Rybakowski MD, PhD & Agnieszka Permoda-Osip

  2. Department of Pediatric Anesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland

    Alicja Bartkowska-Sniatkowska

Authors
  1. Janusz K. Rybakowski MD, PhD
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  2. Agnieszka Permoda-Osip
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  3. Alicja Bartkowska-Sniatkowska
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Correspondence to Janusz K. Rybakowski MD, PhD .

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Editors and Affiliations

  1. Baylor College of Medicine and Michael E. Debakey VA Medical Center, Houston, Texas, USA

    Sanjay J. Mathew

  2. National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA

    Carlos A. Zarate, Jr.

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Rybakowski, J.K., Permoda-Osip, A., Bartkowska-Sniatkowska, A. (2016). Ketamine: Its Safety, Tolerability, and Impact on Neurocognition. In: Mathew, S., Zarate, Jr., C. (eds) Ketamine for Treatment-Resistant Depression. Adis, Cham. https://doi.org/10.1007/978-3-319-42925-0_5

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  • DOI: https://doi.org/10.1007/978-3-319-42925-0_5

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