Opinions in Healthcare

Depression Awareness Month: Ketamine

Depression awareness month takes place each year in October. Depression is a common disorder that affects your mood and how you feel each day. A person may experience persistent sadness, loss of interest in activities that used to bring them joy, changes in appetite and sleep, and feelings of hopelessness. Depression can occur at any age but can be treated.

Ketamine MOA = Ketamine’s mechanism of action is a noncompetitive antagonism of the N-methyl-D-aspartic acid (NMDA) receptor that blocks glutamate. Ketamine also interacts with N-methyl-D-aspartate (NMDA) receptors, opioid receptors, monoaminergic receptors, muscarinic receptors, and voltage-sensitive Ca ion channels. This effect can create a potent anesthetic effect that alters one’s response to one’s surrounding environment.

Uses of Ketamine:

  • Anesthesia
  • Acute and chronic pain management
  • Anti-depression
  • Suicidal behavior
  • Anti-inflammatory

What is bioavailability?

It is the amount of medication that your body can use, which is most times less than the amount of medication that your body was originally administered. When you swallow oral medication, parts of the active drug are digested, altered to inactive ingredients, metabolized, and excreted. Which makes the method of delivery and dose of ketamine very important to achieve therapeutic benefits.

  • IV: 100%
  • Sublingual: 30%
  • IM: 93%
  • Intranasal: Children, Adolescents, Adults: 35% – 50%
  • Oral: 20% – 30%
  • Rectal: Children 2 – 9 years: 25%

Ketamine Methods of Delivery:

Ketamine is water and lipid soluble, allowing it to be administered via various routes. The optimal route of administration of ketamine is intravenous (iv) over 1 minute or at a rate of 0.5 mg/kg/minute to prevent respiratory depression.

Sublingual (under the tongue) allows for increased safety in drug delivery since an individual has a maximum absorption capacity sublingually, preventing overdosing from occurring.

The intramuscular (IM) route is safe and predictable but may be painful upon injection. Intranasal (in) administration allows for rapid absorption and ease in administration. Oral ketamine can be mixed with a flavoring agent and oral syrup. Subcutaneously allows for continuous infusion delivery.

Side effects:

  • Nausea and vomiting
  • Sedation
  • Mood changes
  • Increase or decrease blood pressure
  • Lack of appetite
  • Local skin reaction at the site of administration
  • Increased salivation (co-administration with a small dose of atropine can prevent this)
  • impairing memory

Angela Colasuonno, PharmD 2023 Candidate