Journal
AMERICAN JOURNAL OF PSYCHIATRY
Volume 178, Issue 5, Pages 383-399Publisher
AMER PSYCHIATRIC PUBLISHING, INC
DOI: 10.1176/appi.ajp.2020.20081251
Keywords
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Categories
Funding
- CIHR/GACD/Chinese National Natural Research Foundation
- American Psychiatric Association
- American Society of Psychopharmacology
- Canadian Cancer Society
- Canadian Psychiatric Association
- JosephM. West Family Memorial Fund
- Timeposters Fellowship
- University Health Network Centre for Mental Health
- University of Toronto
- NIH
- AstraZeneca
- National Health and Medical Research Council Senior Principal Research Fellowship [1059660, 1156072]
- a2 Milk Company
- Avant
- Beyond Blue
- Cancer Council of Victoria
- Cooperative Research Centre
- HarryWindsor Foundation
- Meat and Livestock Board
- Medical Benefits Fund
- Medical Research Futures Fund
- National Health and Medical Research Council
- Rotary Health
- Simons Autism Foundation
- Stanley Medical Research Foundation
- Woolworths
- CAPES
- CNPq
- Faculty of Health Sciences
- Department of Psychiatry of Queen's University
- FAPESP
- SEAMO
- Australian Rotary Health Research Fund
- Fondation Fonda Mental
- Geelong Medical Research Foundation
- GlaxoSmithKline
- Mayne Pharma
- Organon
- Simons Foundation
- Stanley Medical Research Institute
- Novartis
- Alcediag-Alcen
- Angelini
- Sage
- Alkermes
- BrainsWay
- LiteCure
- NeoSync
- Roche
- Shire
- Champignon Brands, Inc.
- Cala Health
- Forest
- NIMH
- Mylan
- Neuralstem
- Pamlab
- Patient-Centered Outcomes Research Institute
- Johnson Johnson
- Ridge Diagnostics
- Tal Medical
- Theracos
- Acadia
- AssureRx Health
- Axsome Therapeutics
- BioHaven
- Intracellular
- AB-Biotics
- Abbott
- Dainippon Sumitomo Pharma
- Ferrer
- Gedeon Richter
- Sanofi-Aventis
- Janssen [ESKETINTRD3004]
- Allegan
- Bionomics
- LivaNova
- Sumitomo Dainippon Pharma
- British Medical Association
- Canadian Institutes of Health Research
- CCS Depression Research Fund
- Michael Smith Foundation for Health Research
- MRC
- NARSAD
- NIHR
- Royal College of Physicians of Edinburgh
- Wellcome Trust
- VGH and UBC Hospital Foundation
- Western Economic Diversification Canada
- Avanir
- Braeburn Pharmaceuticals
- Intra-Cellular Therapies
- Ironshore
- ISSWSH
- TMS NeuroHealth Centers
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Replicated international studies have highlighted the human and societal costs of major depressive disorder, with monoamine-based antidepressants proving effective but many patients failing to fully recover. Ketamine and esketamine offer novel pharmacological treatments for treatment-resistant depression, but questions remain about their safety and effectiveness. International experts provide guidance on the use of these agents, while discussing areas of consensus and future research directions.
Replicated international studies have underscored the human and societal costs associated with major depressive disorder. Despite the proven efficacy of monoamine-based antidepressants in major depression, the majority of treated individuals fail to achieve full syndromal and functional recovery with the index and subsequent pharmacological treatments. Ketamine and esketamine represent pharmacologically novel treatment avenues for adults with treatment-resistant depression. Inaddition to providing hope to affected persons, these agents represent the first non-monoaminergic agents with proven rapid-onset efficacy in major depressive disorder. Nevertheless, concerns remain about the safety and tolerability of ketamine and esketamine in mood disorders. Moreover, there is uncertainty about the appropriate position of these agents in treatment algorithms, their comparative effectiveness, and the appropriate setting, infrastructure, and personnel required for their competent and safe implementation. In this article, an international group of mood disorder experts provides a synthesis of the literature with respect to the efficacy, safety, and tolerability of ketamine and esketamine in adults with treatment-resistant depression. The authors also provide guidance for the implementation of these agents in clinical practice, with particular attention to practice parameters at point of care. Areas of consensus and future research vistas are discussed.
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