Citation

Floriano I, Silvinato A, Bernardo WM. Rev. Assoc. Med. Bras. (1992) 2023; 69(4): e2023D694.

Copyright

(Copyright © 2023, Brazilian Medical Association)

DOI

10.1590/1806-9282.2023D694

PMID

37194806

PMCID

PMC10185056

Abstract

Depression is a very common and disabling mental illness and can be assessed by applying several questionnaires, the most common being the Montgomery-Asberg rating scale1, scoring on a scale of 0-60, where 7-19 denotes mild depression, 20-34 moderate depression, and greater than 34 severe depression. Major or severe depression is commonly associated with suicidal ideation, resulting in a suicide attempt or suicide.

Esketamine, the S-enantiomer of racemic ketamine, is an antidepressant with a novel mechanism of action. It is a nonselective, noncompetitive antagonist of the N-methyl-D-aspartate receptor and the ionotropic glutamate receptor. It promotes increased stimulation of the α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptor (AMPAR) and neurotrophic signaling, which restore brain synaptic function. However, the mechanism by which esketamine exerts its antidepressant effect is unknown. Unlike other antidepressant treatments, the primary antidepressant action of esketamine does not directly involve monoamine, GABA, or opioid receptors2.

The aim of this systematic review was to evaluate the use of esketamine compared to placebo in patients with severe depression and suicidal ideation.

Language: en

Keywords

Depression; Depressive Disorder, Major; Humans; Ketamine; Suicidal Ideation