20. Ketamine Part 2, Clinical Uses

Lecture Summary

Ketamine is a small molecule that works mainly through inhibition of the NMDA receptor in brain and nerve tissue.  It has varying effects at different doses and can be used for a number of medical indications including depression, suicidal ideation, acute and chronic pain, sedation, and anesthesia. Ketamine is a very safe drug when used intermittently and appropriately. However, it can cause both harm and addiction. Many clinicians fear ketamine. This fear is misplaced as ketamine is very forgiving in the clinical setting and safer than other alternatives like opiates.

References
-       Olson KR et al. Poisoning and drug Overdose, 6th ed. Arminian P. Phencyclidine and Ketamin. 2012. McGraw Hill. 325-327
-       Nelson LS et al. GoldFrank’s Toxicological Emergencies, 11th ed. Olmedo RE. Phencyclidine and Ketamin, chapter 83. 2019. McGraw Hill. 1210-1221. (NMDA receptor information from other chapters as well)
-       George D et al. Pilot randomized controlled trial of titrated subcutaneous ketamine in older patients with treatment-resistant depression. Am J Geriatr Pscychiatry. 2017; 25(11): 1199-1209.
-       Murrough JW et al. Antidepressant efficacy of ketamine in treatment-resistant major depression: a two-site randomized controlled trial. Am J Psychiatry. 2013; 170(100): 1134-1142.
-       Rodriguez CI et al. Randomized controlled crossover trial of ketamine in obsessive-compulsive disorder: proof-of-concept. Neuropsychopharmacology. 2013; 38:2475-2483.
-       Michelet D et al. Ketamine for chronic non-cancer pain: A meta-analysis and trial sequential analysis of randomized control trials. Eur J Pain. 2018; 22:632-646.
-       Price RB et al. Effects of ketamine on explicit and implicit suicidal cognition: a randomized controlled trial in treatment-resistant depression. Depress Anxiety. 2014; 31(4): 335-343.
-       Lapidus KAB et al. A randomized controlled trial of intrasal ketamine in major depressive disorder. Biol Pscyhiatry. 2014; 76(12): 970-976.
-       Zanos P, Gould TD. Mechanisms of Ketamine Action as an Antidepressant. Mol Psychiatry. 2018; 23(4): 801-811.
-       Orhurhu VJ et al. Ketamine Toxicity. StatPearls. 2020. Available at: https://www.ncbi.nlm.nih.gov/books/NBK541087/
-       Wikipedia – Ketamine, Enantiomers, NMDA, etc.