title: [Ketamine's antidepressant effect: literature review on clinical use].
abstract: BACKGROUND
  Depressive disorders have a major impact on public health. They are prevalent and disabling, with high economic burden for society. Antidepressants have a delayed action and at least one third of patients do not achieve adequate response. The recent discovery of ketamine's unique antidepressant properties, with rapid onset of response and high rate of responders opens new perspectives for treatment-resistant depression (TRD).
  
  
  METHODS
  The aim of this article is to summarize preclinical trials and clinical trials demonstrating ketamine antidepressant properties and to review the different modalities of use.
  
  
  RESULTS
  Most clinical studies used ketamine with a single subanesthetic intravenous administration in patients with treatment-resistant depression, demonstrating a rapid but transient antidepressant response with high response rates. To prevent relapse and maintain the initial benefits, few studies have shown the interest of serial infusions of ketamine, while others combined ketamine and electroconvulsive therapy using the former as an anesthetic. So far, relay treatments with glutamatergic agents such as riluzole are disappointing. Although most studies were conducted in patients with TRD in recurrent depression or bipolar disorder, efficacy in acutely suicidal patients is promising.
  
  
  CONCLUSIONS
  Our review highlights the increasing interest in the use of ketamine in the treatment of treatment-resistant depression. Although a widespread use of ketamine as an antidepressant in routine clinical settings seems limited by psychotomimetic effects and the lack of strategy to maintain initial benefits, ketamine or related drugs might be used to target specific conditions, such as bipolar depression or high suicide risk.
authors.affiliation: Service hospitalo-universitaire de santé mentale et de thérapeutique, centre hospitalier Sainte-Anne, université Paris-Descartes, 1, rue Cabanis, 75014 Paris, France; Inserm UMR 894, centre de psychiatrie et neurosciences, université Paris-Descartes, Sorbonne, Paris Cité, Paris, France. Electronic address: pdemaricourt@gmail.com.
authors.forename: P
authors.initials: P
authors.lastname: De Maricourt
authors.affiliation: Inserm UMR 894, centre de psychiatrie et neurosciences, université Paris-Descartes, Sorbonne, Paris Cité, Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Jay
authors.affiliation: Service du Dr. Zagury, clinique du Bois Bondy, 93G11 EPS Ville Evrard, France.
authors.forename: P
authors.initials: P
authors.lastname: Goncalvès
authors.affiliation: Service hospitalo-universitaire de santé mentale et de thérapeutique, centre hospitalier Sainte-Anne, université Paris-Descartes, 1, rue Cabanis, 75014 Paris, France.
authors.forename: H
authors.initials: H
authors.lastname: Lôo
authors.affiliation: Service hospitalo-universitaire de santé mentale et de thérapeutique, centre hospitalier Sainte-Anne, université Paris-Descartes, 1, rue Cabanis, 75014 Paris, France; Inserm UMR 894, centre de psychiatrie et neurosciences, université Paris-Descartes, Sorbonne, Paris Cité, Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Gaillard
mesh_terms: D003131:Combined Modality Therapy; D061218:Depressive Disorder, Treatment-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004565:Electroconvulsive Therapy; D006801:Humans; D007262:Infusions, Intravenous; D007649:Ketamine / Q000009:adverse effects / Q000627:therapeutic use*; D055502:Secondary Prevention; D000092864:Suicide Prevention
chemical_list: D007649:Ketamine
keywords: Dépression; Dépression résistante; Glutamate; Ketamine; Kétamine; Major depressive disorder; NMDA; NMDA receptors; Treatment-resistant depression