Guidelines for ketamine use in clinical psychiatry practice

Summary & key facts

This editorial explains that ketamine can quickly help some people with depression that has not improved with other treatments. The authors say ketamine is promising, but there are real safety and practical questions when it moves from research into regular clinics. They call for clear, evidence-based national guidelines and for registries that track everyone getting ketamine so doctors can watch for side effects, misuse and long-term outcomes.

Key facts:

• Ketamine and a related drug called esketamine can reduce symptoms in people whose depression did not improve with usual antidepressants.
• The fast benefit of ketamine or esketamine can appear within about 1 to 2 days for some people.
• A nasal spray form of esketamine is licensed in Europe and New Zealand, but major health agencies in some countries have not approved its routine public use.
• Intravenous ketamine is the most studied way to give racemic ketamine to treat resistant depression, while oral and injection forms have much less evidence.
• Both ketamine and esketamine can cause dissociation, changes in thinking or mood, possible increased suicidal thoughts, and other effects on cognition, bladder function and blood pressure, so monitoring is needed.
• Some recent guidelines propose trying an intramuscular dose first to see if a person responds, then switching to an oral plan, with a suggested maximum treatment period of about 12 weeks.
• The authors recommend national or shared registries that record everyone treated with ketamine or esketamine. These registries would help track safety, misuse and long-term outcomes across different doses and ways of giving the drug.

Abstract

In this editorial, we emphasise the efficacy and challenges of using ketamine in treatment-resistant depression. We highlight the need for comprehensive evidence-based guidelines to manage the use of both licensed and off-licence ketamine formulations and discuss recent efforts by Beaglehole et al to develop ketamine guidelines in New Zealand. We finally advocate for national registries to monitor ketamine therapy, ensuring its responsible and effective use in the management of depression.

Topics

Alcoholism and Thiamine Deficiency Treatment of Major Depression Tryptophan and brain disorders

Categories

Health Sciences Medicine Pharmacology

Tags

Clinical Practice Depression (economics) Economics Family medicine Ketamine Macroeconomics Medicine Psychiatry Psychology

Substances

Ketamine

Conditions & symptoms

Addiction Depression Substance abuse disorder Addiction or harmful habbits Difficulty focusing Lack of energy or motivation Sadness or low mood