Ketamine: 50 Years of Modulating the Mind
Ketamine was introduced into clinical practice in the 1960s and continues to be both clinically useful and scientifically fascinating. With considerably diverse molecular targets and neurophysiological properties, ketamine’s effects on the central nervous system remain incompletely understood. Investigators have leveraged the unique characteristics of ketamine to explore the invariant, fundamental mechanisms of anesthetic action. Emerging evidence indicates that ketamine-mediated anesthesia may occur via disruption of corticocortical information transfer in a frontal-to-parietal (“top down”) distribution. This proposed mechanism of general anesthesia has since been demonstrated with anesthetics in other pharmacological classes as well. Ketamine remains invaluable to the fields of anesthesiology and critical care medicine, in large part due to its ability to maintain cardiorespiratory stability while providing effective sedation and analgesia. Furthermore, there may be an emerging role for ketamine in treatment of refractory depression and Post-Traumatic Stress Disorder. In this article, we review the history of ketamine, its pharmacology, putative mechanisms of action and current clinical applications.
A qualitative study of patients' experience of ketamine treatment for depression: The ‘Ketamine and me’ project
Ketamine in Bipolar Disorder: A Review
The Future of Ketamine in the Treatment of Teen Depression
Single and repeated ketamine infusions for reduction of suicidal ideation in treatment-resistant depression
Single, Repeated, and Maintenance Ketamine Infusions for Treatment-Resistant Depression: A Randomized Controlled Trial
Efficacy, Safety, and Durability of Repeated Ketamine Infusions for Comorbid Posttraumatic Stress Disorder and Treatment-Resistant Depression.
The Pros and Cons of Ketamine for Obsessive-Compulsive Disorder
Ketamine and Treatment-Resistant Depression
Ketamine and Complex Regional Pain Syndrome
- Correll, Maleki et al. “Subanesthetic ketamine infusion therapy: a retrospective analysis of a novel therapeutic approach to complex regional pain syndrome.” Pain Medicine. 2004 Sep;5(3):263-75.
SUMMARY: This article reviewed 33 cases of patients with CRPS that were treated with Ketamine infusion. The patients received a prolonged low dose infusion of ketamine, on average 10-20mg/hr over 2-4 days. 76% of patients experienced complete pain relief after the first course of treatment. Pain relief lasted at least three months for most patients. Adding a second course of treatment allowed over 50% to be pain free for over a year. One patient had to discontinue additional treatments after the first infusion after developing elevated liver enzymes. These did normalize after treatment was stopped.
Ketamine and Chronic Pain Syndromes (headache, CRPS and back pain)
- Patil S, Anitescu M. “Efficacy of outpatient ketamine infusions in refractory chronic pain syndromes: a 5-year retrospective analysis. Pain Medicine. 2012 Feb;13(2):263-9.
Ketamine and PTSD
- Feder, Parides et al. “Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: a randomized clinical trial.” JAMA Psychiatry. 2014 Jun;71(6):681-8.