ANALYSIS OF THE USE OF THE PSYCHEDELIC DRUG KETAMINE FOR TREATMENT OF DEPRESSION IN THE ELDERLY: A LITERATURE REVIEW

Abstract

Introduction: Population aging presents an unusual morbidity and mortality profile, with a reduction in infectious diseases and an increase in chronic-degenerative diseases, such as depression, which affects around 30% of the elderly. Depression is a complex condition, influenced by biological, psychological and social factors. Although there are more than eight classes of antidepressants on the market, only 30 to 35% of patients respond adequately to treatment. One of these medications is ketamine, traditionally used as an anesthetic, which has demonstrated effectiveness in resistant depression. Studies suggest that its action on neurotransmitters, such as glutamate, is capable of mitigating depressive symptoms by blocking N-methyl-D-aspartate (NMDA) receptors and activating others that stimulate the neuroplasticity of synapses, such as α-amino-3-hydroxy -5-methylisoxazole-4-acidopropionic acid (AMPA). The present work aims to synthesize findings on the use of ketamine in the treatment of depression in the elderly through a literature review. Objective: Understand the effects of using ketamine in the elderly to treat depression. Methodology: Literature review carried out in the Pubmed, Scielo, Lilacs database on articles that met the inclusion, exclusion and descriptor criteria. Results: Studies indicate significant improvements after 8 initial infusions of ketamine, highlighting benefits such as psychological well-being and reduction of suicidal ideas in patients over 60 years of age. Although its effectiveness has been observed in the elderly, comparisons with younger adults revealed greater responsiveness in the latter when starting treatment early. Ketamine has also been shown to be effective in treating catatonic depression in the elderly, presenting positive results as an alternative to electroconvulsive therapy in situations such as the pandemic and restrictive comorbidities. Research with ketamine nasal spray in France showed a reduction in Montgomery-Åsberg Depression Scale scores, but the ideal dose for elderly people in this study was not defined. Another study on dosage in elderly military veterans indicates a greater probability of safety and efficacy of response with 0.5mg ketamine, which has a better probability of treatment compared to midazolam. Reviews highlight the scarcity of literature on this subject, which is a limitation, despite promising results to date. Conclusion: Ketamine is promising for resistant depression in the elderly, although results are uncertain. Its use demonstrates rapid remission, but challenges, such as defining the ideal dose, method of administration and understanding long-term effects, persist. Therefore, additional research is needed to provide more specific guidelines for clinical practice, aiming to improve the treatment of depression in the elderly.