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Minerva Psychiatry 2021 September;62(3):120-31

DOI: 10.23736/S2724-6612.21.02068-9


language: English

Ketamine: use in psychiatry, its pharmacology and treatment following intoxication

Ramadhan ORUCH 1 , Ian F. PRYME 2, Ole B. FASMER 3, 4, Anders LUND 3, 4

1 School of Medicine, Department of Biochemistry and Molecular Biology, Najran University, Najran, Saudi Arabia; 2 School of Medicine, Department of Biomedicine, University of Bergen, Bergen, Norway; 3 Section of Psychiatry, Department of Clinical Medicine, University of Bergen, Bergen, Norway; 4 Division of Psychiatry, Haukeland University Hospital, Bergen, Norway

Suicidal ideas emerge as a consequence of major depression, failure of therapy, depressive stupor, treatment-resistant catatonia and prolonged severe mania of bipolar affective disorder; and these are sometimes difficult to treat. Urgent and efficient treatment is necessary in these cases where suicide can be a potential outcome. Suicidal ideations can also arise when antidepressants, especially those of the SSRI type without being gradually tapered, are abruptly discontinued by a mishap or lack of knowledge. In all such cases urgent solutions will be necessary to avoid these individuals from committing suicide. After institutionalizing the patient, psychiatrists have two potent methods that can be used to prevent suicide. These are electroconvulsive therapy and intravenous ketamine administration. Electroconvulsive therapy (as a physical means) has an absolute indication, especially in those cases mentioned above; however, it also has its own hazards. Ketamine as a biological means can give excellent relief and save these individuals from an impending risk of suicide. In expert hands ketamine should be favored over electroconvulsive therapy in these situations. The drug has a convenient route of administration. Here we have discussed all aspects of ketamine with special emphasis on clinical indications, pharmacology and how to treat intoxication. Psychiatrists, junior residents of psychiatric units and other psychiatric caregivers are considered as the main audience for this work.

KEY WORDS: Ketamine; Receptors, N-methyl-D-aspartate; Depressive disorder; Suicide; Anesthetics

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