Objective This study evaluated whether intramuscular (IM) ketamine is non‐inferior to intranasal (IN) esketamine for treatment‐resistant depression (TRD) and assessed differences in safety and healthcare costs. Methods In a retrospective, observational sequential cohort at the VA San Diego, 179 Veterans with TRD received eight treatments of either IN esketamine ( n = 89) or IM ketamine ( n =...
Ketamine promotes spine growth on the apical dendrites of pyramidal neurons in the prefrontal cortex (PFC), which are critical for its behavioral effects. Follow-up studies show that brain-derived neurotrophic factor (BDNF) signaling is critical for these effects. In this context, we sought to determine if microglial BDNF contributes to the synaptic and behavioral effects of ketamine....
OBJECTIVES To describe a case of ketamine-induced cystitis (KIC) in a middle-aged patient using ketamine recreationally, highlight diagnostic pitfalls that may lead to unnecessary antibiotics, and offer pharmacist-focused recommendations for assessment and management, including a formal causality assessment using the Naranjo algorithm. CASE SUMMARY A 56-year-old male with escalating...
In this paper, which is in part intended as a speculative provocation and which combines philosophy of science, clinical practice and psychedelic therapy in a novel manner, we examine ketamine-assisted psychotherapy (KAP) through the lens of an expanded model of enactive cognition. While much work within both KAP and psychedelic-assisted therapy (PAT) in general has relied upon broadly...
ABSTRACT: Introduction Ketamine and esketamine have reemerged as promising interventions for treatment-resistant depression (TRD), yet debate persists regarding the clinical relevance of acute dissociative experiences. This secondary exploratory analysis examined the relationship between dissociative experiences induced by subcutaneous esketamine and antidepressant response in patients with...
Neuroinflammation, particularly Toll-like receptor 4 (TLR4)-mediated signaling, plays a critical role in the pathophysiology of depression. This study aimed to investigate the mechanisms by which S-ketamine (S-ket) and S-hydroxynorketamine (S-HNK) modulate TLR4 and peroxisome proliferator-activated receptor alpha (PPARα) signaling in the prefrontal cortex (PFC) to exert antidepressant effects....
Over the past two decades, ketamine has emerged as a rapid-acting antidepressant, especially among patients with treatment-resistant depression. As an N-methyl-d-aspartate glutamate receptor antagonist, ketamine has reshaped the understanding of the underlying neurobiological mechanisms of depression treatment. Ketamine induces a transient state of enhanced neuroplasticity and likely...
Abstract Aim Ketamine is increasingly used for treatment-resistant depression, bipolar disorder, PTSD, chronic pain, and other psychiatric conditions[8,9]. As more adults receive serial ketamine infusions or intranasal esketamine, perioperative considerations with ongoing NMDA-receptor modulation. However, perioperative guidance remains limited, creating uncertainty around anesthetic dosing,...
INTRODUCTION: Ketamine, initially developed as an anesthetic and now increasingly prescribed for treatment-resistant depression, is also widely misused in recreational contexts. Chronic ketamine use, often leading to dependence, has been associated with severe physical complications, including ulcerative cystitis and gastrointestinal dysfunction, as well as cognitive, affective, and psychotic...
Psychiatric ServicesJuly 1, 2026Joshua Mitchell, Benjamin Bregman, Renuka Surujnarain et al.
Aided by COVID-19-era regulatory flexibilities, direct-to-consumer telemedicine has expanded access to mental health care. Ketamine prescribed off-label for psychiatric conditions is increasingly marketed online and delivered at home through telehealth platforms. Taking a wrongful death lawsuit against a telehealth ketamine provider as a point of departure, the authors examine how combining...