Prevention and Management of Common Adverse Effects of Ketamine and Esketamine in Patients with Mood Disorders

• Published in: CNS drugs Vol. 35; no. 9; pp. 925 - 934
• Main Authors: Ceban, Felicia, Rosenblat, Joshua D., Kratiuk, Kevin, Lee, Yena, Rodrigues, Nelson B., Gill, Hartej, Subramaniapillai, Mehala, Nasri, Flora, Lui, Leanna M. W., Lipsitz, Orly, Kumar, Anil, Lee, Jung Goo, Chau, Edmond H., Cao, Bing, Lin, Kangguang, Ho, Roger C., Mansur, Rodrigo B., Swainson, Jennifer, McIntyre, Roger S.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-09-2021; Springer Nature B.V
• Subjects: Administration, Intranasal; Administration, Intravenous; Adverse events; Antidepressants; Antidepressive Agents - administration & dosage; Antidepressive Agents - adverse effects; Anxiety; Anxiety - chemically induced; Bias; Blood pressure; Clinical significance; Clinical trials; Disease Management; Drug abuse; Drug-Related Side Effects and Adverse Reactions - diagnosis; Drug-Related Side Effects and Adverse Reactions - prevention & control; Drug-Related Side Effects and Adverse Reactions - psychology; Emotional disorders; Familiarity; Gastrointestinal Diseases - chemically induced; Humans; Industrial safety; Ketamine; Ketamine - administration & dosage; Ketamine - adverse effects; Medicine; Medicine & Public Health; Mental depression; Mood; Mood disorders; Mood Disorders - diagnosis; Mood Disorders - drug therapy; Mood Disorders - psychology; Nausea; Nausea - chemically induced; Neurology; Neurosciences; Patient education; Patients; Pharmacotherapy; Prevention; Psychiatry; Psychopharmacology; Side effects; Suicides & suicide attempts; Systematic review; Therapy in Practice
• ISSN: 1172-7047; 1179-1934
• DOI: 10.1007/s40263-021-00846-5

The emerging roles of ketamine and esketamine as effective rapid-acting antidepressants hold promise for patients suffering from treatment-resistant depression and/or major depressive disorder with suicidality. Practitioner familiarity with common tolerability/safety concerns along with pragmatic prevention and management strategies are needed to reduce patient burden and improve the acceptability and accessibility of these treatments. The most common treatment-emergent adverse events associated with ketamine/esketamine are dissociation, anxiety, nausea, increased blood pressure, and headache. The majority of side effects are mild, transient, dose dependent, and attenuate with subsequent treatments. Patient selection, baseline physical and psychiatric assessments, and an appropriate setting are critical first steps in the prevention and mitigation of adverse events. Patient education and supportive interventions play central roles in the prevention and management of select adverse events. Severe and/or clinically significant adverse effects may necessitate the judicious use of adjunctive medications. Moreover, practitioners must remain vigilant to the potential for abuse liability and long-term adverse events, for which there are insufficient data. This article succinctly reviews common treatment-emergent adverse events of ketamine and esketamine within the context of mood disorders, and provides practical suggestions for prevention and management at point-of-care.