Ketamine is increasingly used for treatment-resistant depression, especially after FDA approval of esketamine, yet significant barriers to access remain. Intravenous administration is the most common method, with intramuscular and sublingual routes emerging. Patients are predominantly middle-aged (36-64 years old), and financial obstacles due to limited insurance coverage are notable. Access is limited in rural areas, and private clinics offer more flexible treatment than hospitals. The absence of long-term outcome data and variability in protocols underscore the need for standardization and further research.
Ketamine, particularly intravenous (IV) ketamine, is increasingly used off-label for treatment-resistant depression (TRD), despite only esketamine being FDA-approved. A scoping review of two survey-based studies found IV administration is the most common method, with intramuscular and sublingual routes used less often. Patients are predominantly middle-aged (36-64 years), and financial barriers are notable due to limited insurance coverage and out-of-pocket costs. Geographic disparities limit access in rural areas. Private clinics offer more flexible treatment approaches than hospitals. The review emphasizes the need for standardized protocols, expanded insurance coverage, and further research due to variability in practices and absence of long-term outcome data.
A panel of experts from the American Society of Ketamine Physicians, Psychotherapists, and Practitioners used a Delphi process to develop consensus guidelines for administering intravenous ketamine infusions to treat depressive disorders. The guidelines provide recommendations on patient selection, dosing, safety monitoring, and treatment protocols, aiming to standardize clinical practice and improve patient outcomes. The consensus reflects agreement among specialists on best practices for this off-label use of ketamine.