Ketamine as a Mental Health Treatment

Summary & key facts

This article explains that ketamine is being used more and more as a possible treatment for people whose depression, anxiety, or post-traumatic stress disorder did not get better with usual medicines. Ketamine was approved long ago as an anesthetic in 1970, and a related drug called esketamine (sold as Spravato) was approved for hard-to-treat depression in 2019. Doctors and clinics now offer ketamine in different ways — as a nasal spray, as injections, combined with therapy, or even in at-home programs — but the research is still changing and the rules for how it is used are unclear. The paper is written so nurses can better understand the science, safety, and ethical questions when patients ask about or receive ketamine treatment.

Key facts:

• Researchers say ketamine looks promising as a treatment for people with depression, anxiety, or PTSD who did not get better with standard medicines.
• Ketamine was first approved by U.S. regulators in 1970 for use as an anesthetic, and a version called esketamine was approved for treatment-resistant depression in 2019.
• Ketamine is being given in several ways: a nasal spray (esketamine), intravenous infusions, combined with psychotherapy, and in some at-home programs.
• The scientific evidence about ketamine for mental health is still evolving, so we do not yet have a settled picture of long-term benefits and risks.
• Regulation and oversight of ketamine use in mental health are fragmented, which means rules and clinical practices vary a lot between places.
• This article focuses on practical and ethical issues nurses should know when advising patients who are considering or receiving ketamine treatment.

Abstract

ABSTRACT: Ketamine has emerged as a promising intervention for treatment-resistant mental health disorders, such as depression, anxiety, and posttraumatic stress disorder. With rising global mental health burdens and the limitations of existing pharmacological treatments, ketamine's novel mechanism of action provides a potential alternative for individuals who have not responded to traditional therapies. Ketamine was initially approved by the U.S. Food and Drug Administration in 1970 for use as an anesthetic, and over the past two decades, has increasingly been investigated and used as an off-label treatment for mental health disorders. Additionally, the S-ketamine enantiomer of ketamine, esketamine (marketed as Spravato), received approval for treatment-resistant depression in 2019. Clinical applications of ketamine in the treatment of mental health disorders include intranasal administration (esketamine), IV infusions, ketamine-assisted psychotherapy, and at-home therapy, with varying levels of oversight. The current ketamine landscape has created a perfect storm in which the regulation of ketamine's use in mental health treatment remains fragmented, the evidence is constantly evolving, and a vulnerable population of individuals who are struggling with treatment-resistant mental health symptoms are desperate for relief. This article addresses these considerations by providing a foundation of clinical information that nurses should understand as they advise patients who are receiving, or curious about ketamine, as well as by discussing the regulatory, ethical, and nursing implications of using ketamine in the treatment of mental health disorders.

Topics

Digital Mental Health Interventions Treatment of Major Depression Tryptophan and brain disorders

Categories

Health Sciences Medicine Pharmacology

Tags

Action (physics) Clinical trial Depression (economics) Food and drug administration Global mental health Health care Intervention (counseling) Ketamine Major depressive disorder Medicine MEDLINE Mental health Population Psychiatry Treatment-resistant depression

Substances

Ketamine

Conditions & symptoms

Anxiety Depression PTSD Anxiety or worry Feeling disconnected from others Sadness or low mood