Ketamine/Esketamine in Clinical Practice: Areas of Consensus and Nonconsensus from an American Society of Clinical Psychopharmacology (ASCP) Delphi Panel Task Force.
Gerard Sanacora, Joseph F. Goldberg, Roger S McIntyre, Lisa Harding, Michael Berk, Siegfried Kasper, Cristina Cusin, Sanjay J. Mathew, James W. Murrough, Dan V. Iosifescu, Samuel T. Wilkinson, Sandhya Prashad, Eduard Vieta, Joshua D. Rosenblat, Elizabeth D. Ballard, Balwinder Singh, Sagar V Parikh, Sara Costi, Allan H. Young, Rupert McShane, Carlos A. Zarate
The Journal of Clinical Psychiatry November 2, 2026 DOI: 10.4088/jcp.26cs16585 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Delphi consensus study Peer reviewed |
|---|---|
| Sample size | 21 |
| Population | International panel of academic mood disorder psychopharmacologist-psychiatrists with expertise in ketamine/esketamine clinical care and research |
| Topics | Esketamine Ketamine |
| Key points | Consensus was reached on only 35 of 105 items (33%) regarding practical ketamine/esketamine use in mood disorders. The authors conclude that consensus agreement appears elusive for many key decision points, reflecting substantial disparities between real-world clinical practice and the clinical trials evidence base, with uncertainties persisting about novel formulations (oral or intramuscular), high-dose ketamine infusions, ketamine-assisted psychotherapy, and use in conditions other than major depression. |
Abstract
Objective: Important aspects of ketamine/esketamine treatment for mood disorders in contemporary practice remain inadequately addressed by the current evidence base, necessitating expert guidance in areas where clinical decision needs and implementation have advanced more rapidly than available data. The American Society of Clinical Psychopharmacology convened an expert task force to address unresolved questions about the practical use of these agents in "real-world" settings and potential disparities with evidence-based literature.
Participants: An international panel of 21 academic mood disorder psychopharmacologist-psychiatrists with expertise in ketamine/esketamine clinical care and research. Evidence: Consensus was reached on 35/105 items (33%), encompassing domains involving diagnostic conditions, contraindications, maximum dosing, racemic versus enantiomeric preparations, oral or intramuscular delivery formulations, laboratory/safety monitoring, access, and parameters for judging treatment outcome. Consensus Process: Two successive Delphi rounds were completed alongside multiple virtual, email, and in-person meetings. Consensus was defined a priori as ≥75% agreement/disagreement on 5-point Likert survey items. All authors contributed to the interpretation and drafting of recommendations.
Conclusions: Consensus agreement appears elusive for many key decision points involving ketamine/esketamine treatment, reflecting substantial disparities between "real-world" clinical practice and the shortcomings of the clinical trials' evidence base. Uncertainties persist regarding the use of novel formulations (eg, oral or intramuscular), high-dose ketamine infusions, ketamine-assisted psychotherapy, and use in conditions other than major depression. These areas of expert consensus and dissent lay the groundwork for future studies urgently needed to bridge the gap between evidence-based findings and treatment implementation in routine clinical settings.