Caution Is Warranted in Prescribing Ketamine for Mental Health.
Katherine Drabiak
Journal of General Internal Medicine April 1, 2026 DOI: 10.1007/s11606-025-10024-8 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Topics | Esketamine Ketamine |
| Citations | 2 |
| Key findings | Telehealth services prescribing off-label racemic ketamine account for about half the ketamine market, and providers should evaluate evidence, risk-benefit, and patient best interests when considering off-label prescribing. |
Abstract
Clinics across the USA advertise ketamine as an alternative solution for mental health conditions. Ketamine has expanded into a multibillion-dollar industry, with three delivery models: (1) in-person clinics offering off-label racemic ketamine; (2) clinic visits for esketamine (Spravato); and (3) telehealth services prescribing off-label racemic ketamine. About half of the market encompasses telehealth using off-label prescribing. This article describes the legal changes behind the growth of telehealth-only providers, differences in patient monitoring requirements, and implications for patient safety. While providers can legally prescribe medications off-label, providers should consider three questions to determine whether off-label prescribing is clinically and ethically appropriate. Providers should evaluate: (1) whether sound evidence exists to prescribe; (2) whether drug benefits outweigh the risks; (3) and whether prescribing serves the patient's best interests. As a dissociative anesthetic, ketamine raises significant concerns regarding whether the purpose and function of the drug meet legal requirements for appropriate prescribing of controlled substances.
Comparable studies
Other narrative reviews on ketamine, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms | 2018 | Review | |
| Mechanisms of Ketamine Action as an Antidepressant | 2018 | Review | |
| Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation Adults with treatment-resistant depression | 2021 | Review | |
| Ketamine Pharmacology: An Update (Pharmacodynamics and Molecular Aspects, Recent Findings) | 2013 | Review | |
| A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders | 2017 | Review and consensus statement |
Citations in the library
Cited by 2
Cites 4
- The Rapidly Shifting Ketamine Landscape in the US JAMA Psychiatry January 3, 2024
- At-home, telehealth-supported ketamine treatment for depression: Findings from longitudinal, machine learning and symptom network analysis of real-world data. Journal of Affective Disorders September 15, 2024
- Safety considerations and risk mitigation strategies for ketamine use: a comprehensive review. Annals of Medicine and Surgery May 1, 2025
- Esketamine for treatment resistant depression: a trick of smoke and mirrors? Epidemiology and Psychiatric Sciences 2020