Many women who could become pregnant receive ketamine for psychiatric conditions, but risks to a developing fetus are frequently overlooked. A survey of U.S. outpatient ketamine clinics found that fewer than half discuss pregnancy-related risks during informed consent, only 20% require pregnancy tests before treatment, and just 13.7% recommend or require contraception. A record review at one academic medical center showed all patients were tested weekly for pregnancy, but only half used contraception. The findings indicate a need for greater attention to reproductive health in ketamine treatment protocols.
Ketamine is increasingly used for psychiatric disorders outside academic settings, but little is known about real-world practices. A survey of U.S. community-based ketamine clinics and a review of their websites found that all clinics use ketamine for treatment-resistant depression, and many also prescribe it for treatment-naive depression (72.3%), bipolar depression (78.9%), and subclinical depression (59.7%). Over 80% of clinics offer maintenance treatment, often for prolonged periods, and over 40% provide ketamine for at-home use. Fewer than 30% of clinics are run by psychiatric physicians, and over 25% by nonphysician providers. The findings indicate significant variability in indications, duration, formulations, and settings, highlighting a need for increased oversight and specific practice guidelines.
Psilocybin-assisted therapy may hold promise for anorexia nervosa, a serious and often treatment-resistant illness. Although research has focused on adults, anorexia frequently begins in adolescence, and early onset is linked to more severe illness, greater psychiatric comorbidity, and more life difficulties. The authors argue that exploring the theoretical potential of this therapy for adolescents is warranted, considering biological implications, developmental stage, and consent. They propose adaptations to adult treatment models and discuss emerging models that address the unique challenges of adolescent patients.
Trainees in medical and allied professions learn about psychedelics and related therapies mainly from social media and word-of-mouth, sources that do not improve their knowledge. Structured education is scarce, and overall psychedelic literacy is low, but those who participate in programming at their own institutions show greater knowledge. As psychedelic therapies become more available and research advances, academic training programs must include relevant material to prepare future professionals to educate and counsel patients.