Ketamine for Depression, 4: In What Dose, at What Rate, by What Route, for How Long, and at What Frequency?

Ketamine for Depression, 6: Effects on Suicidal Ideation and Possible Use as Crisis Intervention in Patients at Suicide Risk

“…Therefore, if unanswered questions (Table 2) can be resolved in favor of ketamine, subanesthetic dosing with ketamine may become an important crisis intervention strategy to buy time while other treatments are instituted and take effect. 23 As discussed in earlier articles in this series, 1,2,4 respiratory risks with ketamine are low, even in anesthetic doses, and the drug is relatively safe, even in untrained hands, such as when used in military medical emergencies. An important possibility, then, is that ketamine may be a potential pharmacologic crisis intervention for the suicidal patient even in low-resource, primary care settings in developing countries, where facilities for psychiatric admission, psychotherapy, and ECT are unavailable.…”

“…P revious articles in this column discussed the efficacy, adverse effects, and possible mechanism(s) of action of subanesthetic doses of ketamine in the treatment of depression 1 ; the indications and contexts for the use of ketamine as an off-label antidepressant 2 ; the antidepressant benefits and adverse effects of ketamine and its enantiomers 3 ; issues related to dosing, rate of administration, route of administration, duration of treatment, and frequency of sessions when ketamine is used to treat depression 4 ; and potential pharmacokinetic and pharmacodynamic interactions when ketamine is used as an offlabel treatment for depression. 5 The present article examines the effects of ketamine on suicidal ideation and its possible use as a pharmacologic crisis intervention in patients at suicide risk.…”

“…In this context, there is need to explore whether oral or subcutaneous ketamine is also effective with appropriate dose adjustments to compensate for poor bioavailability and other pharmacokinetics matters. 4 Given that elaborate monitoring facilities are unlikely to be available in lowresource settings, the risk-benefit profile of ketamine in such settings requires study, and minimum standards of care require to be set. There are already reports in the literature of the safe and effective domiciliary self-administration of sublingual ketamine, as required, in patients with suicidal ideation.…”

Intravenous ketamine infusion for a patient with treatment-resistant major depression: a 10-month follow-up

“…1,[6][7][8]10,11 Although its exact mechanisms of action in major depression remain unclear, abnormal reduction in glutamate and glial cell density has been associated with major depression. 1,[6][7][8]10,11 Although its exact mechanisms of action in major depression remain unclear, abnormal reduction in glutamate and glial cell density has been associated with major depression.…”

Ketamine for Depression, 5: Potential Pharmacokinetic and Pharmacodynamic Drug Interactions

“…4 The present article examines potential pharmacokinetic and pharmacodynamic interactions when ketamine is used as an off-label treatment for depression.…”