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Table of Contents
  • Ketamine and Esketamine
    • Primer
    • Mechanism of Action
    • Safety Concerns
    • Resources
  • Last edited on December 14, 2021

Ketamine and Esketamine

Table of Contents
  • Ketamine and Esketamine
    • Primer
    • Mechanism of Action
    • Safety Concerns
    • Resources

Primer

Ketamine is a non-competitive NMDA receptor antagonist with a potent anesthetic effect. Esketamine is the S(+) enantiomer of ketamine.

Mechanism of Action

  • Esketamine also acts to some extent as a dopamine reuptake inhibitor but, unlike ketamine, does not interact with the sigma receptors.

Safety Concerns

  • Turner, E. H. (2019). Esketamine for treatment-resistant depression: seven concerns about efficacy and FDA approval. The Lancet Psychiatry, 6(12), 977-979.
  • Gastaldon, C., Raschi, E., Kane, J. M., Barbui, C., & Schoretsanitis, G. (2020). Post-Marketing Safety Concerns with Esketamine: A Disproportionality Analysis of Spontaneous Reports Submitted to the FDA Adverse Event Reporting System. Psychotherapy and Psychosomatics, 1-8.

Resources

  • Schatzberg, A. F. (2019). A Word to the Wise About Intranasal Esketamine. American Journal of Psychiatry, appi-ajp.
  • Horowitz MA, Moncrieff J. Are we repeating mistakes of the past? A review of the evidence for esketamine. Br J Psychiatry. 2020;1‐4. doi:10.1192/bjp.2020.89
  • Cristea, I. A., & Naudet, F. (2019). US Food and Drug Administration approval of esketamine and brexanolone. The Lancet Psychiatry, 6(12), 975-977.
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