Today, three more burning questions about ketamine and es ketamine, and the new research

that attempts to answer them.

Welcome to the Carlyte Psychiatry Podcast, keeping psychiatry honest since 2003.

I'm Chris Akin, the editor-chief of the Carlatte Psychiatry Report.

And I'm Kelly Newsom, a psych-n-p, and a dedicated reader of every issue.

Ketamine and S-Ketamine treat depression.

But they leave a lot of questions unanswered.

And last week, we covered three of them.

How does it compare to quittipine? It works a little better.

How does it compare to ECT? Depends on the setting. We're seeing better responses to ECT in

hospitalized and psychotic depression and better responses to ketamine in outpatient depression.

And how effective is it? That depends on which placebo you compare it to.

Compared to intravenous saline, the effect is huge, but when compared to an intravenous benzo,

it's a lot smaller, but still in the respectable large range. And that brings us to question four.

Which version is more effective?

Ketamine or S-Ketamine?

Let's start with animal models.

In animal models, there was some suggestion at first that the R-Ketamine, the R-anantyamer,

had stronger antidepressant effects than S-Ketamine, the one that got FDA approved.

But, you know, then I saw studies showing the opposite, so it's just not clear.

Besides being different in antioemers, they also have different routes of delivery.

Ketamine is IV and S-Ketamine intranasal.

...