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Ketamine for mental health - A naturalistic inventory of prescribing practices, safety, and adverse effects

Marta Stuart, Ian Stefanuk, Rebecca Comeau, Atul Khullar, Jennifer Swainson

PLOS mental health April 2, 2025 DOI: 10.1371/journal.pmen.0000215 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Survey Peer reviewed
Sample size 45
Population Ketamine prescribers, with emphasis on psychiatric care providers, across two countries
Topics Ketamine Esketamine
Keywords Adverse effect Mental health Pharmacology
Citations 1
Key findings Non-IV ketamine was commonly used and reported to have a favorable safety profile, suggesting that safety depends on dose and route and that universal regulations may unnecessarily limit access.

Abstract

Ketamine is an NMDA receptor antagonist, long used for its anesthetic and pain reducing properties, but has more recently demonstrated efficacy for treating depression. Evidence is also emerging for other psychiatric indications including posttraumatic stress disorder, anxiety disorders, obsessive compulsive disorder, and to support psychotherapy. In this context, there is greater demand for its use in various forms including intravenous, intramuscular, subcutaneous, intranasal, oral, and sublingual administration. While intravenous administration typically requires administration and monitoring in a healthcare setting, the safety precautions for other forms of ketamine are unclear. Limited data in this regard may elicit controversy among prescribers, who wish to improve patient access, and among regulatory bodies, who may impose limitations based on IV ketamine data. This project aims to bridge the gap between current literature and the clinical experience and opinions of ketamine prescribers. This information was obtained in the form of a survey and answered: "How do prescribers of ketamine, with emphasis on psychiatric care providers, find its safety profile and in what ways have they prescribed ketamine?" Information was gathered on prescriber profiles, indications for ketamine use, doses and routes of ketamine prescribed, side effects and adverse events, and prescribers' opinions regarding monitoring requirements. Results were obtained from 45 providers with more than 1000 patient encounters over two countries. Non-IV forms of ketamine were commonly used, and the survey reported a favorable safety profile for ketamine. Non-IV Ketamine was reported to be safely utilized in a clinic setting with minimal monitoring and safety equipment, or at times, for home use. While survey results carry limitations, it appears that safety is dependent on dose and route, and strict universal regulations for all formulations may unnecessarily limit patient access.

Comparable studies

Other cross-sectional and survey studies on ketamine, most cited first.

Study Year Design Participants
5-Year Trends in Use of Hallucinogens and Other Adjunct Drugs among UK Dance Drug Users People who use drugs in dance contexts 2006 Repeated-measures cross-sectional survey
Preliminary analysis of positive and negative syndrome scale in ketamine-associated psychosis in comparison with schizophrenia Healthy subjects, ketamine abusers, and schizophrenia patients 2014 Cross-sectional study n = 998
Ketamine as a primary predictor of out-of-body experiences associated with multiple substance use Online survey respondents 2011 Cross-sectional survey n = 192
Self-reported prevalence of dependence of MDMA compared to cocaine, mephedrone and ketamine among a sample of recreational poly-drug users Global non-treatment-seeking sample of last year users of MDMA, cocaine, mephedrone,... 2014 Cross-sectional survey
Near-Death States Reported in a Sample of 50 Misusers Previous ketamine misusers who reported a ketamine-related near-death experience 2010 Cross-sectional survey n = 50

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Ketamine Esketamine Addiction Anxiety Depression