Depressive disorder is a common mental health condition that causes significant personal suffering, functional limitations, loss of productivity, and high healthcare costs. Although various treatments are available, they do not work for everyone. Therefore, there is a need for new treatment methods.
Ketamine is originally developed as an anesthetic. Since 2000, it has also been studied as a potential antidepressant. In her dissertation, Sanne Smith-Apeldoorn studied whether esketamine, the left-handed enantiomer of ketamine, can help people with difficult-to-treat depression: a depression that does not respond well to existing treatments.
Her research focused on three main questions: 1) Is esketamine effective and safe for difficult-to-treat depression? 2) Is oral administration of esketamine effective and safe? If so, according to which treatment regimen? 3) Is ketamine maintenance treatment in general, and oral esketamine maintenance treatment specifically, effective and safe?
To answer these questions she conducted literature reviews, a small pilot study, and a larger placebo-controlled trial. She also reviewed the results of an off-label treatment program that she developed with her colleagues. The results are cautiously positive: oral esketamine could be a safe and effective treatment for patients with difficult-to-treat depression, provided it is dosed sufficiently high and tailored to individual needs. At the same time, there are limitations to the research, meaning that no firm conclusions can yet be drawn. Smith-Apeldoorn suggests areas for further research, with the ultimate goal of improving the treatment of patients with depression.
Sanne Smith-Apeldoorn is part of Health in Context.
