Ketamine — NMDA receptor antagonist / dissociative anesthetic

The key differentiator between IV racemic ketamine (off-label, widely used) and Spravato (FDA-approved) is the regulatory framework. Spravato requires REMS certification — patients must be observed for 2 hours post-dose at the clinic. IV ketamine is prescribed off-label by anesthesiologists/psychiatrists and allows home discharge after monitoring. R-ketamine is being investigated as it may have fewer dissociative side effects while maintaining antidepressant efficacy. Ketamine's antidepressant effects typically last 2-3 weeks after single infusion; maintenance dosing schedule varies.

نظرة عامة

هذه الصفحة جزء من مكتبة المركّبات المُصنَّفة بالأدلة في Hormonaly. جميع الادعاءات السريرية مرتبطة بمصادر علمية مُحكَّمة عبر خط أنابيب التحقق المزدوج للاستشهادات.

فئة المركّب

NMDA receptor antagonist / dissociative anesthetic

آلية العمل

Non-competitive NMDA glutamate receptor antagonist. At sub-anesthetic doses, produces rapid antidepressant effect via: (1) AMPA receptor throughput enhancement (glutamate burst), (2) BDNF/TrkB signaling and synaptogenesis, (3) mTOR pathway activation (rapid synapse formation in PFC), (4) inhibition of lateral habenula "anti-reward center" burst firing. Effect onset: within hours (vs weeks for SSRIs). Esketamine (S-enantiomer, Spravato) is the FDA-approved intranasal formulation — 2x more potent at NMDA receptor vs R-enantiomer; administered in certified healthcare settings due to dissociation/BP monitoring requirements. IV racemic ketamine widely used off-label at infusion clinics.

الوضع التنظيمي

Ketamine HCl: FDA approved 1970 (anesthetic); Spravato: FDA approved 2019 (TRD, MDD with SI)

مستوى الأدلة

High for Spravato (FDA-approved Phase 3 data); High for IV anesthesia; Moderate for off-label IV depression