Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada.
Braxia Health, Mississauga, ON, Canada.
CNS Drugs. 2021 Sep;35(9):925-934. doi: 10.1007/s40263-021-00846-5. Epub 2021 Aug 7.
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.
氯胺酮和 Esketamine 作为有效快速抗抑郁药的新兴作用，为治疗抵抗性抑郁症和/或伴有自杀意念的重性抑郁症患者带来了希望。为了减轻患者负担，提高这些治疗方法的可接受性和可及性，临床医生需要熟悉常见的耐受性/安全性问题，以及实用的预防和管理策略。与氯胺酮/ Esketamine 相关的最常见的治疗中出现的不良事件是分离、焦虑、恶心、血压升高和头痛。大多数副作用是轻微的、短暂的、剂量依赖性的，并随着后续治疗而减轻。患者选择、基线身体和精神评估以及适当的环境是预防和减轻不良事件的关键第一步。患者教育和支持性干预在预防和管理特定不良事件中发挥着核心作用。严重和/或临床显著的不良影响可能需要谨慎使用辅助药物。此外，临床医生必须警惕滥用的可能性和长期的不良事件，因为目前数据不足。本文简洁地回顾了氯胺酮和 Esketamine 在心境障碍中的常见治疗中出现的不良事件，并提供了在护理点预防和管理的实用建议。
