Multidisciplinary development of guidelines for ketamine treatment for treatment-resistant major depression disorder for use by adult specialist mental health services in New Zealand
B. Beaglehole, P. Glue, Mike Clarke, Richard Porter
BJPsych Open October 13, 2023 DOI: 10.1192/bjo.2023.577 via Semantic Scholar
Summary
New Zealand clinicians developed practical guidelines for using ketamine to treat treatment-resistant major depressive disorder in publicly funded specialist mental health services. The guidelines offer two treatment pathways: a test of responsiveness with intramuscular ketamine followed by a 3-month course of oral ketamine, aiming to maximize short-term benefits. The guidance was created through consultation with senior leadership, clinical pharmacy, psychiatrists, nursing, service users, and Māori mental health workers.
Study at a glance
| Characteristics | Guideline development with consultation Peer reviewed |
|---|---|
| Keywords | Medicine Psychology |
| Citations | 9 |
| Key finding | Ketamine treatment guidelines for treatment-resistant major depressive disorder were developed, featuring two pathways including an intramuscular responsiveness test and a 3-month oral ketamine course. |
Abstract
Background The evidence base for racemic ketamine treatment for treatment-resistant major depressive disorder (TRD) continues to expand, but there are major challenges translating this evidence base into routine clinical care. Aim To prepare guidelines for ketamine treatment of TRD that are suitable for routine use by publicly funded specialist mental health services. Method We consulted with senior leadership, clinical pharmacy, psychiatrists, nursing, service users and Māori mental health workers on issues relating to ketamine treatment. We prepared treatment guidelines taking the evidence base for ketamine treatment and the consultation into account. Results Ketamine treatment guidance is reported. This offers two treatment pathways, including a test of ketamine responsiveness with intramuscular ketamine and the dominant use of oral ketamine for a 3-month course to maximise the opportunity for the short-term benefits of ketamine to accumulate. Conclusions We have responded to the challenges of translating the evidence base for ketamine treatment into a form suitable for routine care.