Ketamine or Esketamine use in people with hard-to-treat depression and special health needs

Approximately 50% of patients with treatment-resistant depression (TRD) respond to conventional antidepressant drugs.

• Ketamine and esketamine exhibit efficacy in various TRD subpopulations, including geriatric, psychiatric, neurologic, oncologic, pediatric, and obstetric patients.
• Key challenges associated with ketamine and esketamine include managing psychotomimetic effects, potential for substance abuse, and cardiovascular adverse effects.
• Preliminary data on arketamine suggest it may offer longer-lasting antidepressant effects with fewer psychomotor adverse effects and lower abuse potential.
• Findings regarding ketamine and esketamine in patients with multiple comorbidities are encouraging but based on very small sample sizes.
• Larger, well-designed clinical trials are urgently needed to establish definitive efficacy and safety profiles across diverse populations.

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