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Basic psychopharmacology
Published in Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson, Pocket Prescriber Psychiatry, 2019
Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson
Memantine is a voltage-dependent NMDA antagonist used in Alzheimer's disease to block putative neuronal excitotoxicity. The recreational drugs ketamine and PCP are non-voltage-dependent NMDA antagonists that can cause euphoria and psychosis. Esketamine, the S-enantiomer of ketamine, is a novel antidepressant.
Benefits of Meditation and Yoga in Clinically Depressed Patients
Published in Anne George, Snigdha S. Babu, M. P. Ajithkumar, Sabu Thomas, Holistic Healthcare. Volume 2: Possibilities and Challenges, 2019
Madhuri Tolahunase, Rajesh Sagar, Rima Dada
Novel approaches are being considered, which improve neuroplasticity and other biological mechanisms. Parenteral or intranasal administration of the glutamatergic drugs ketamine or esketamine, which are antagonists of N-methyl-d-aspartate.Intravenous scopolamine.The opioid modulator ALKS 5461.
Misuse, Recreational Use, and Addiction in Relation to Prescription Medicines
Published in Ornella Corazza, Andres Roman-Urrestarazu, Handbook of Novel Psychoactive Substances, 2018
Francesco S. Bersani, Claudio Imperatori
Ketamine is a dissociative anaesthetic that produces catalepsy, catatonia, and amnesia but not necessarily complete unconsciousness (Hernandez & Nelson, 2010). It is extensively used in anaesthesia and its S(+)enantiomer, esketamine, is in phase III clinical trials for treatment of major depressive disorder (Correia-Melo et al., 2017). Ketamine acts primarily as an antagonist of the NMDA receptor, but its full mechanism is not well understood (Tyler, Yourish, Ionescu, & Haggarty, 2017). As reviewed by Schifano et al. in 2008, ketamine misuse as a recreational drug has been implicated in deaths globally, with more than 20 deaths in the United Kingdom in the years 1993–2006 and 87 deaths in New York City between 1997 and 1999; fatalities include accidental poisonings, drownings, traffic accidents, and suicide (Schifano, Corkery, Oyefeso, Tonia, & Ghodse, 2008). As reported by Hernandez and Nelson in 2010, users usually obtain ketamine through diversion from legitimate suppliers of the drug rather than through prescriptions in circulation; it is a white powder that is soluble in water and alcohol and can be snorted, injected, applied on smokable materials, or consumed in drinks (Hernandez & Nelson, 2010).
Access and real-world use patterns of esketamine nasal spray among patients with treatment-resistant depression covered by private or public insurance
Published in Current Medical Research and Opinion, 2023
Amanda Teeple, Maryia Zhdanava, Dominic Pilon, Gabrielle Caron-Lapointe, Patrick Lefebvre, Kruti Joshi
Esketamine is a novel nasal spray approved, in combination with an oral antidepressant, for TRD in adults in the US8. In a phase 3 double-blind, active-controlled, multicenter study esketamine reduced depressive symptoms in as early as 24 h after the first dose9; in the phase 3 TRANSFORM-1 multicenter study, although statistical significance was not reached for the primary efficacy endpoint, the treatment effect of esketamine on depressive symptom reduction exceeded what has been considered clinically meaningful for approved antidepressants when compared with placebo9,10. Esketamine in combination with an oral antidepressant has also been shown to be significantly more effective in preventing relapse of TRD compared to oral antidepressant monotherapy11.
Association of anhedonia and suicidal ideation in patients with treatment-refractory depression after intravenous ketamine infusions
Published in International Journal of Psychiatry in Clinical Practice, 2023
Wei Zheng, Li-Mei Gu, Xin-Hu Yang, Yan-Ling Zhou, Cheng-Yu Wang, Xiao-Feng Lan, Bin Zhang, Yu-Ping Ning
In this study, anhedonia, as measured by the MADRS, did not appear to be associated with suicidal ideation after the participants received serial ketamine infusions. However, a recent study using the SHAPS to assess anhedonia found that anhedonia may be significantly related to suicidal ideation at baseline and after a single intravenous infusion of ketamine, independent of depression (Ballard et al., 2017). Studies of the association between the BDI anhedonia subscale and suicidal ideation have been performed but with inconsistent findings (Ballard et al., 2017; Ducasse et al., 2018; Winer et al., 2014). For example, Ballard et al.’s study did not support an association between the BDI anhedonia subscale and suicidal ideation at baseline and after a single intravenous infusion of ketamine (Ballard et al., 2017). Another study found that the baseline BDI anhedonia subscale may be a robust predictor of suicidal ideation (Winer et al., 2014). A possible explanation is that the rapid-acting effects of ketamine are more related to experiences of pleasure, which may be better evaluated by the SHAPS, rather than an overall lack of interest as measured by the MADRS or BDI anhedonia subscales (Ballard et al., 2017). Similar to ketamine (Ballard et al., 2014; Lally et al., 2014; 2015), esketamine also has an rapid antidepressant and antianhedonic effects for patients with depression (Canuso et al., 2018; Delfino et al., 2021). However, the association between anhedonia and suicidal ideation after serial esketamine infusions is unclear.
Intravenous esketamine leads to an increase in impulsive and suicidal behaviour in a patient with recurrent major depression and borderline personality disorder
Published in The World Journal of Biological Psychiatry, 2022
Thomas Vanicek, Jakob Unterholzner, Rupert Lanzenberger, Angela Naderi-Heiden, Siegfried Kasper, Nicole Praschak-Rieder
After obtaining informed consent, the patient was treated with esketamine (Ketanest®S), administered intravenously (i.v.) over 40–60 min. In total, she received five esketamine 25 or 50 mg administrations during a time period of two weeks (every other day during workdays) according to treatment guidelines (Sanacora et al. 2017). Initially, esketamine caused immediate improvement of depressive symptoms and a temporary reduction of suicidal ideation. However, as the treatment regimen with esketamine went on, more side effects, such as loosening of impulsive control and disinhibition occurred. Subsequent to the 5th infusion she made another suicide attempt via drug intoxication. At that time, she was not open to rational argumentation and was mentally constrained to her feelings of absolute hopelessness. Due to this additional symptom worsening under esketamine, no further i.v. esketamine administrations were applied. In addition to duloxetine 90 mg, trazodone 150 mg, lithium 450 mg, topiramate 50 mg and Clonazepam 1 mg, psychopharmacological treatment was augmented with olanzapine, up to 30 mg, and aripiprazole 10 mg. This treatment did not cause meaningful side effects and proved beneficial. With this psychopharmacological combination therapy an improvement of depressive symptoms as well as stabilisation of impulsivity could be achieved within a week. At the time of discharge, depressive symptoms had attenuated significantly, there was no sign of suicidality, though symptoms of unstable self-image and instable social interactions persisted.