Frontiers in psychiatry
January 1, 2023
Carson Chrenek, Bryan Duong, Atul Khullar et al.
23 citations
Intravenous ketamine and intranasal esketamine are effective for treatment-resistant depression but are limited by cost, availability, and monitoring requirements. A literature review up to June 2023 and a community case study from two public hospital sites in Edmonton, Canada, describe how evidence on ketamine for treatment-resistant depression can be applied in real-world settings. The paper synthesizes knowledge on off-label racemic ketamine versus FDA-approved esketamine, dosing, safety, and long-term maintenance. To overcome cost barriers, public programs may incorporate sublingual or intranasal ketamine. Three such sustainable treatment models are described, though large-scale randomized trials and long-term outcome data remain lacking.
Psychiatry research
September 1, 2026
Isis Lunsky, Gilmar Gutierrez, Xena Wang et al.
Postpartum depression (PPD) is common and harmful if untreated, with few effective prevention strategies. Ketamine and esketamine are rapid-acting antidepressants showing promise for PPD. This review searched five databases for peer-reviewed randomized controlled trials, pilot studies, and observational studies examining ketamine or esketamine for PPD prevention during pregnancy or postpartum, for both cesarean and vaginal deliveries. A network meta-analysis and narrative synthesis were used. Thirty-six studies were identified; five included vaginal delivery, thirty included cesarean section, and one did not specify delivery mode. Results suggested that ketamine and esketamine were well tolerated and may reduce PPD risk. However, data quality was low to very low, so results should be interpreted cautiously. More high-quality studies are needed.
Ketamine
January 1, 2025
Carson Chrenek, Jennifer Swainson
Access to effective ketamine treatments for treatment-resistant depression is limited by cost, availability, and monitoring requirements. This article synthesizes current literature on ketamine's pharmacology and describes its application in a clinical program in Edmonton, Alberta. Topics include the rationale for maintenance treatments, monitoring long-term safety, and alternative options such as sublingual or at-home ketamine to improve patient access. The authors review considerations for cautious prescribing outside highly monitored settings.
Journal of Clinical Psychopharmacology
August 1, 2018
Shaina Archer, Carson Chrenek, Jennifer Swainson
In a small group of 11 patients with treatment-resistant depression who initially responded to an acute course of ketamine infusions, ongoing maintenance infusions helped sustain the antidepressant effect for some. All patients had lower depression scores during maintenance treatment than at baseline. At the end of the observation period, 4 patients continued maintenance ketamine, 1 switched to intranasal ketamine, 4 stopped because the drug lost its effect, 1 stopped due to side effects, and for 2 the reason was unrecorded. No major adverse events occurred, and the treatment was generally well tolerated. The authors suggest maintenance ketamine may help some responders, but more research is needed on optimal duration and long-term safety.