Ketamina eta esketaminaren erabilera depresioerresistentea tratatzeko: etorkizunerako erronkak

Abstract

Depressive disorders have become one of the major public health problems in recent years, not only because of their impact on quality of life, but also because of the partial response or lack of response to antidepressant treatment. Therefore, the rapid and potent antidepressant effect of (R,S)-ketamine (ketamine) is considered one of the most important psychiatric discoveries of the last decades. Although, intravenous administration of ketamine has prevailed in most clinical trials conducted so far, the intranasal route has been considered a useful and safe alternative. Thus, the FDA (Food and Drug Administration) and the EMA (European Medicines Agency) approved a esketamine nasal spray named Spravato for the use in treatment resistant depression, although clinical trials supporting its marketing are not long-term. In line with this, major long-term safety concerns, such as dependence and cognitive impairment, has not been assessed so far. Therefore, there is an urgent need to investigate the relevance ofrepeated administration protocols on the long-term antidepressant response and safety. In this regard, potential pharmacological interactions between ketamine and some antidepressant drugs and benzodiazepines may impact the antidepressant response. In fact, while in some clinical trials adjunctive antidepressant medication is allowed, in others it is specifically removed, and this pharmacological variability may alter the efficacy of the treatment. Consequently, it is undeniable that in addition to massive long-term clinical trials, post-marketing studies are necessary to ensure the safety and efficacy of long-term ketamine and esketamine use.