Ketamine and depression

Since Domino and colleagues reported the first clinical use of ketamine more than half a century ago there have been many clinical and laboratory studies to determine both mechanism(s) of action and the most appropriate clinically useful properties of this enigmatic drug. These include analgesia, favourable cardio-respiratory profile, anti-inflammatory effects and anti-cancer actions. In addition to this, anti-depressant actions of ketamine have been recognized that are of clinical applicability. In psychiatry, many clinical studies demonstrate that existing antidepressant medications show limited effectiveness and slow onset of clinical response. Indeed, development of new therapeutic strategies for major depression represents a major clinical need and represents an area where there is much pharmaceutical interest. Does ketamine fit the bill? In this editorial, this new facet is explored in terms of utility and mechanisms of actions.