Over the past 50 years, the use of ketamine for anesthesia has become widespread in both human and veterinary medicine. Its safety and short duration and unique mode of action have made ketamine an important drug in emergency medicine and pain management around the world. The study and use of ketamine for the treatment of several new indications, ranging from pain syndromes to drug addiction and psychiatric disorders, is constantly growing. In experimental research, ketamine has unarguably contributed to a better understanding of the glutamatergic system and the development of animal models of schizophrenia [
1].
Perhaps the greatest contribution to the legacy of ketamine has been the discovery of its rapid-acting antidepressant effects [
2], which has effectively revitalized interest in the development of new antidepressant drugs with a novel mode of action. Indeed, the past decade has seen a rapid increase in the number of research papers associated with ketamine’s antidepressant effects [
3]. It can be argued that even beyond its important role in anesthesia, ketamine is a top contender for being the drug with the largest impact for research and treatment of psychiatric disorders in the past several decades.
The ability of ketamine to provide a rapid relief of depressive symptoms, often within hours, has brought it to the forefront of treating severe treatment-resistant depression [
4]. Despite its relatively fast pharmacokinetics, the antidepressant effects of ketamine are sustained for up to 1–2 weeks [
5]. This rapid onset of ketamine’s action combined with a sustained response lasting far beyond its acute pharmacological effects has puzzled researchers and medical doctors. In contrast, typical antidepressant drugs, such as selective serotonin reuptake inhibitors, often require weeks or even months of continuous medication to elicit their beneficial effects [
6]. While the last 2 decades of basic and clinical research have significantly contributed to the understanding of ketamine’s complex profile of effects and its potential for the treatment of psychiatric disorders, the precise neurobiological basis of its antidepressant action remains unclear.
With a vast amount of research aimed at untangling the mysteries of its action, an ever-increasing number of molecular targets and mechanisms have been associated with the antidepressant effects of ketamine [
7]. A myriad of novel drug candidates, essentially mimicking certain aspects of ketamine’s action, have risen out of preclinical research. However, to date, no new drug has conformed to the high expectations, with multiple candidates failing in recent clinical trials [
8–
10]. The shortcomings of animal models of depression are often discussed as a plausible explanation for these failures of translational research, but many other aspects also require further examination. In the rush to understand the molecular complexities of ketamine’s action, both basic and clinical researches have overlooked details related to the administration and dosing time of ketamine [
11,
12]. For example, studies directly comparing different dosing parameters and pharmacokinetics between human and rodent studies are still lacking.
With many new ketamine studies published each year, staying up to date becomes a challenge. Thus, the purpose of this review is both to introduce the reader to the various uses of ketamine from anesthesia to pain management and psychiatric use and to provide a thorough overview of the current understanding of ketamine’s effects in treating depression. Herein, the multifaceted profile of ketamine’s effects is reviewed, and studies addressing molecular, cellular, and network mechanisms are introduced. A special emphasis is placed on discussing issues associated with the dosing of ketamine in both basic and clinical research as well as on discussing some of the latest hypotheses related to ketamine’s antidepressant mechanisms.