Ketamine as an Antidepressant

The FDA's approval of esketamine (which is a derivative of the anesthetic drug ketamine) for treatment of depression has been hailed as a ‘game changer’ in the treatment of major depressive disorders. The exact mechanism of action of this drug still remains mostly unknown. There has been a rush of theories mostly focused on the neurotransmitter glutamate. As a psychiatrist who has practiced and followed the research over the last three decades, I am unconvinced by this explanation and its reductionistic, pseudoscientific description.

Let’s face it: This is an anesthetic and a club drug with side effects which include detachment, depersonalization and cardiovascular problems. The mechanism of action seems to be more related to possible anesthetic affects on the opioid system of the brain and the experiential effect of being detached from one’s reality. I am happy that we have more options to alleviate the pain and suffering of depression, but a rush to conclusions on the causes of depression seems premature.

Moreover I’m extremely concerned that there are clinics popping up everywhere not staffed by properly trained physicians in psychiatric medicine. If you are seeking this type of treatment I urge you to seek out an established medical center supervised by a board-certified psychiatrist experienced in all aspects of psychiatric care, not just the infusion or administration of ketamine products.