Oral ketamine for the treatment of pain and treatment-resistant depression

Abstract

Oral ketamine, given for longer time periods in the described doses, appears to be well tolerated, but few studies have systematically examined the longer-term negative consequences. The short- and longer-term depression outcomes as well as side-effects need to be studied with rigorous randomised controlled trials.

Ketamine for Depression, 5: Potential Pharmacokinetic and Pharmacodynamic Drug Interactions

“…[9][10][11] In this context, it may inhibit the glucuronidation of morphine (in patients who are also receiving this drug for pain management), as suggested by the results of an in vitro study. 12 There is no information available, so far, on whether this interaction is clinically significant.…”

Chronic Pain and Suicide: Is There a Role for Ketamine?

“…Over half of the patients given ketamine during this trial showed significant improvement in pain and depression with few side effects. 14,22 While patients with depression and comorbid PTSD who also experience chronic pain are known to have higher suicide rates, we speculate that effective treatment of all conditions may be associated with reductions in suicidal behavior. Until this is confirmed by future research, we believe it is imperative that providers who treat patients for chronic pain screen for suicidality and mental illness.…”

“…21 Ketamine is a well-known anesthetic with analgesic effects that can be used to treat chronic pain in a range of disorders. 14,22 There is ample evidence in the field of pain management that both oral and IV ketamine are effective treatments. Current indications for the use of oral ketamine include neuropathic pain, complex regional pain syndrome, cancer pain, orofacial pain, and phantom limb pain.…”

“…The therapeutic effect of ketamine in the treatment of both depression and chronic pain is believed to be the result of antagonism of the NMDAR. 14,22 The effects of ketamine on pain, anxiety, and depression were studied in a palliative health care setting. One case from this study described a hospice patient who was treated daily with 40 mg of oral ketamine and reported relief from all three complaints.…”

Spaces for mood care: prevention and intervention in digital, community and health systems

“…Severe depression in elderly people and in individuals with depression with psychosis appears to show the best response to ECT. This has driven a search for new approaches such as ketamine [11][12][13] and even opiates.…”