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As of June 2017, esketamine, the S( ) enantiomer of ketamine, is in phase III clinical trials for intranasal treatment of depression.
Ketamine is given by a single intravenous infusion at doses less than those used in anesthesia, and preliminary data indicate it produces a rapid (within 2 hours) and relatively sustained (about 1–2 weeks long) reduction in symptoms in some people.
Further follow-up is required to fully assess the efficacy of these treatments.
In case reports of three people treated with esketamine for relief of chronic pain, liver enzyme abnormalities occurred following repeat treatment with ketamine infusions, with the liver enzyme values returning below the upper reference limit of normal range on cessation of the drug.
Other treatments have been used, including antibiotics, NSAIDs, steroids, anticholinergics, and cystodistension.
The time of onset of lower urinary tract symptoms varies depending, in part, on the severity and chronicity of ketamine use; however, it is unclear whether the severity and chronicity of ketamine use corresponds linearly to the presentation of these symptoms.
The same study also demonstrated chronic (24 h) administration of ketamine at concentrations as low as 0.01 μg/ml can interfere with the maintenance of dendritic arbor architecture.
These results raise the possibility that chronic exposure to low, subanesthetic concentrations of ketamine, while not affecting cell survival, could still impair neuronal maintenance and development.
Meta-analyses have shown overwhelming clinical evidence to support the acute efficacy of ketamine in severely unwell populations, but a lack of data on optimal dosing and the effect of long-term treatment.
Currently, ketamine is not approved for the treatment of depression, and so this is an off-label use.