Australian & New Zealand Journal of Psychiatry
November 15, 2019
Katrina Witt, Jennifer Potts, Anna A.m. Hubers et al.
203 citations
A single infusion of ketamine may reduce suicidal thoughts in people with treatment-resistant depression within four hours, and the effect can last up to 72 hours. The analysis combined 15 randomized controlled trials with 572 participants, mostly with mood disorders. At four hours after infusion, suicidal ideation scores dropped significantly (standardized mean difference -0.51), and the reduction persisted through 72 hours (standardized mean difference -0.57 to -0.63 at different intervals) but not beyond. Results varied widely across studies, and evidence quality was moderate to low. There were almost no data on whether ketamine prevents actual suicide attempts or self-harm. Further trials are needed to confirm these findings and find ways to sustain the anti-suicidal effect.
British Journal of Psychiatry
July 14, 2023
Colleen Loo, N. Glozier, D. Barton et al.
70 citations
In a phase 3 trial across seven mood disorders centers in Australia and New Zealand, subcutaneous racemic ketamine was tested against midazolam for treatment-resistant depression. With flexible dosing (0.5–0.9 mg/kg), ketamine led to a 19.6% remission rate compared to 2.0% for midazolam, a significant difference. Fixed dosing (0.5 mg/kg) showed no difference. Acute side effects, such as psychotomimetic effects and blood pressure increases, resolved within two hours. The subcutaneous route proved practical and feasible.
Australian & New Zealand Journal of Psychiatry
March 21, 2021
Daniel Perkins, Jerome Sarris, Susan L. Rossell et al.
53 citations
Psychedelic substances such as psilocybin, ayahuasca, LSD, and MDMA are gaining renewed medical interest due to the need for new psychiatric treatments and promising study results. This viewpoint reflects on the Royal Australian and New Zealand College of Psychiatrists' Clinical Memorandum on Psychedelics and notes regulatory developments, including applications for down-scheduling and access approvals. The authors argue that rigorous research is needed to assess benefits, safety, and therapeutic mechanisms. They summarize recent findings on mechanisms of action and the psychedelic-assisted psychotherapy model, suggesting medicinal psychedelics could become a new class of psychiatric treatments when used under medical supervision with psychotherapeutic support. However, sufficiently powered trials and safety protocols are required before clinical use, and untrained practitioner access could be harmful.
BJPsych Open
June 7, 2023
Nicollette Thornton, Jason Kawalsky, Alyssa Milton et al.
11 citations
A systematic review of 119 print and online news articles from 2015 to 2020 found that media coverage of ketamine for psychiatric disorders was extremely positive (68.9% of articles). The rapid antidepressant effect was frequently emphasized (73.1% of articles), while longer-term safety and efficacy received little attention. Side-effects were reported in 80.7% of articles, mainly acute psychotomimetic effects and addiction risk, but rarely cardiovascular or bladder effects. Key opinion leaders, such as clinicians, often provided overly optimistic quotes that went beyond the existing evidence base. The authors conclude that information shaping patient expectations is being communicated through the media, and clinicians should address patients' beliefs directly.
The Australian and New Zealand journal of psychiatry
April 28, 2025
Salam Hussain, Chris Gale, Shanthi Sarma et al.
10 citations
The Royal Australian and New Zealand College of Psychiatrists has developed professional practice guidelines for using ketamine in psychiatric care in Australia and Aotearoa New Zealand. Based on scientific evidence and expert clinical consensus, the guidelines aim to help psychiatrists and clinicians deliver best practice and optimize patient outcomes. They balance promoting evidence-based practice with recognizing that evidence for ketamine use is still evolving.
The Australian and New Zealand journal of psychiatry
February 1, 2024
Anthony Rodgers, Dilara Bahceci, Christopher G Davey et al.
8 citations
The repurposing of generic racemic ketamine for severe depression has been delayed and uncoordinated for over 20 years due to insufficient commercial incentives, while a patented intranasal formulation (Spravato) gained widespread registration through substantial commercial investment. Spravato costs $600-$900 per dose compared to about $5 per dose for generic ketamine, and an annual government investment of approximately AUD$100 million in Australia was rejected twice, leaving the treatment largely inaccessible. Emerging evidence suggests generic ketamine is at least as effective as Spravato, but no comparative trials have been conducted. Without systemic reforms—including commercial incentives, public funding, reduced regulatory barriers, and coordinated international support—this pattern will repeat with new psychedelic treatments.
Psychiatry research
February 1, 2025
Adam Bayes, Thanh Vinh Cao, Ana Rita Barreiros et al.
6 citations
Ketamine and its derivatives are increasingly used for treatment-resistant depression, but they can cause side effects during and between treatment sessions. The Ketamine Side Effect Tool (KSET) was designed to monitor these effects, but its length limited its use in clinics. Using retrospective data from three outpatient services, researchers calculated how often side effects occurred within sessions, between sessions, and at follow-up. They then developed a shorter version, the KSET-Revised (KSET-R), which showed good construct and concurrent validity for specific items and an overall tolerability rating. The revised tool is more feasible for clinical practice and is recommended for monitoring side effects in patients receiving ketamine treatment.
Translational psychiatry
January 23, 2026
Stevan Nikolin, Clara Massaneda-Tuneu, Louise Brettell et al.
1 citation
Electroconvulsive therapy (ECT) leads to a faster reduction in depressive symptoms than ketamine for severe, medication-resistant depression. A meta-analysis of seven studies with 731 participants found that depression scores were slightly lower at baseline in the ketamine group. After adjusting for baseline differences, ECT produced an additional improvement of about 0.02 standardized mean difference per day, amounting to a predicted moderate advantage over ketamine after four weeks. This advantage falls within the range considered clinically meaningful.
The British Journal of Psychiatry
July 6, 2026
Nick Glozier, Richard W. Morris, Elizabeth Stratton et al.
A 4-week course of subcutaneous racemic ketamine produced short-term clinical benefit in a minority of people with treatment-resistant depression, with response rates declining substantially after treatment cessation. Among 130 participants, 30% responded at treatment end (Montgomery-Åsberg Depression Rating Scale reduction ≥50%), but only 17% remained responders 4 weeks later, and over 50% experienced less than a 25% reduction in depression scores. No difference in response was found between fixed and flexible dosing regimens. Prior ketamine treatment during an earlier randomized trial did not affect later outcomes. No suicides or suicidal behavior requiring admission occurred, and only expected side effects were observed.
Archives of suicide research : official journal of the International Academy for Suicide Research
May 9, 2026
Gregory Carter, Maree Hackett, Stevan Nikolin et al.
Ketamine's effect on suicidal ideation in adults with treatment-resistant depression remains uncertain. In a phase III double-blind randomized trial comparing subcutaneous racemic ketamine to midazolam over four weeks, one cohort showed no significant difference between groups on either the MADRS item 10 or the C-SSRS measure of suicidal ideation. A second cohort showed a non-significant reduction on the MADRS item 10 but a significant reduction on the C-SSRS. Baseline suicidal ideation scores were low in both cohorts. Adverse events requiring clinical review occurred in 13.8% of all treatment sessions. The authors suggest flexible-dose subcutaneous racemic ketamine may have beneficial effects on suicidal ideation scores, but future studies need to be powered for suicidal ideation as a primary outcome.