Michael Alvear

Systematic Reviews and Meta-Analyses of Ketamine Therapy for Depression (2020–2024) A Comparative Evidence Summary

Michael Alvear preprint

This report summarizes more than 25 systematic reviews and meta-analyses published between 2020 and 2025 on ketamine-based therapies for depression. It provides a comparative analysis of intravenous (IV) ketamine, esketamine nasal spray (Spravato), and oral ketamine, highlighting differences in response rates, remission rates, speed of symptom relief, and durability of results.It also examines...

DOI: 10.31234/osf.io/tjvzr_v1 (opens in new tab)

No Standard Dosing For Oral Ketamine Exists: A Systematic Audit of Oral and Sublingual Ketamine Dosing Across 26 Depression Studies and Its Implications for Patient Safety

SSRN Electronic Journal Michael Alvear

Background: Oral and sublingual ketamine for depression is being prescribed to tens of thousands of patients through telehealth services with no FDA-approved dosing protocol, no clinical guideline covering this route of administration, and no publicly available synthesis of what clinical researchers have actually tested. A prior surveillance study of patient-reported experiences documented a...

DOI: 10.2139/ssrn.6802679 (opens in new tab)

Ketamine and Esketamine for Suicidal Ideation: A Stratified Evidence Synthesis Across Intravenous, Intranasal, and Injection Routes (2016–2026)

SSRN Electronic Journal Michael Alvear

This white paper reports a stratified evidence synthesis of 31 peer-reviewed studies (2016–2026) examining ketamine and esketamine as rapid-acting treatments for suicidal ideation. Studies were classified by administration route — intravenous racemic ketamine (14 primary studies, N=1,258), intranasal esketamine/Spravato (6 primary studies, N=844), and injection routes combining intramuscular...

DOI: 10.2139/ssrn.6979838 (opens in new tab)

Death and Near-Death Experiences in Ketamine and Psychedelic Therapy

Michael Alvear

Patients undergoing ketamine-or psychedelic-assisted therapy for cancer-related distress, treatment-resistant depression, or end-of-life existential fear frequently report experiences resembling death or near-death: a sense of leaving the body, encountering something transcendent, or having died and returned. This synthesis reviews peer-reviewed evidence on how often this occurs, why it may...

DOI: 10.2139/ssrn.7206360 (opens in new tab)