Ketamine for depression
Ketamine for depression
This thesis of Jolien Veraart explores the use of ketamine in people with treatment-resistant depression. It starts by examining the concept of treatment-resistant depression, a term that is widely used but poorly defined. Importantly, this label may negatively influence patients’ expectations and sense of hope. As an alternative, more neutral framing is suggested.
Survey data from individuals seeking ketamine treatment show that many have been suffering from depressive symptoms for years and are dissatisfied with standard treatments. At the same time, there is strong interest in innovative approaches. The thesis therefore focuses on the clinical potential of oral esketamine, studied both in a randomized controlled trial and in real-world clinical practice. Fixed low doses were not effective, but higher, individualized dosing led to meaningful improvement in a subgroup of patients.
The thesis further examines ketamine treatment in patients with complex and comorbid forms of depression, including those with psychotic symptoms, post-traumatic stress disorder (PTSD), and patients receiving maintenance electroconvulsive therapy (ECT). In these populations, ketamine was often effective and well tolerated, particularly when provided in a supportive and carefully monitored setting. Combining ketamine with psychotherapy appears promising, although more controlled research is needed.
Finally, the thesis addresses important pharmacological issues such as drug–drug interactions, the safety of combining ketamine with MAO inhibitors, and variability in blood levels. A key finding is the possible occurrence of auto-induction, meaning that repeated oral use may speed up ketamine’s own metabolism, potentially reducing its long-term effectiveness. Overall, this work offers practical guidance for the safe and thoughtful use of ketamine in clinical practice.