Lancet Psychiatry
April 5, 2017
Ilina Singh, Celia Morgan, Valerie Curran et al.
158 citations
Based on current evidence, off-label ketamine use for severe, treatment-resistant depression does not violate ethical principles, but clinicians and professional bodies must establish guidelines for good practice, register all trial data, and continuously monitor risks. The analysis reviews evidence for ketamine's antidepressant effects and safety profile, concluding with recommendations for oversight bodies to support safe, effective, and ethical treatment.
BJPsych Open
January 1, 2021
Karen Lascelles, Lisa Marzano, Fiona Brand et al.
20 citations
Twelve fee-paying patients with treatment-resistant depression (ages 21–70, six women and six men, most reporting suicidality and some reporting self-harm) were interviewed before, during, and months after starting ketamine treatment in a routine clinic. Nearly all experienced mood improvement after initial treatments, ranging from negligible to dramatic, and eight reported reduced suicidality. Improvements were generally transitory; two patients had sustained consistent benefit and two had sustained but limited improvement. Some described hopelessness when treatment stopped working, and three experienced increased suicidal ideation. Side-effects were common and significant for two patients. Treatment cost and lack of longer-term benefit were problematic. Suggestions included closer monitoring and adjunctive therapy.
BJPsych Open
July 29, 2019
Sagar Jilka, Claire A. Murray, Ania M. Wieczorek et al.
20 citations
Patients and carers want better evidence on the long-term safety of ketamine for major depression and feel that monitoring is required, though they worry about misuse of that information. Practical barriers such as repeated travel to clinics and lack of sufficiently informed medical staff are key concerns. The study used 44 participants in 21 focus groups and an online survey, generating ten themes including monitoring, information, side-effects, recreational use, effectiveness, cost, stigma, and therapy.
BJPsych open
May 10, 2024
Luke A Jelen, Rupert McShane, Allan H Young
7 citations
Ketamine shows promise for treatment-resistant depression, but its use requires careful management through evidence-based guidelines. The editorial emphasizes the need for comprehensive protocols to oversee both licensed and off-licence ketamine formulations, referencing recent efforts to develop such guidelines in New Zealand. It advocates for national registries to monitor ketamine therapy, ensuring responsible and effective treatment for depression.
J Affect Disord
May 16, 2026
David S. Mathai, Madeleine Cluck, Amna M. Aslam et al.
1 citation
A panel of experts from the American Society of Ketamine Physicians, Psychotherapists, and Practitioners used a Delphi process to develop consensus guidelines for administering intravenous ketamine infusions to treat depressive disorders. The guidelines provide recommendations on patient selection, dosing, safety monitoring, and treatment protocols, aiming to standardize clinical practice and improve patient outcomes. The consensus reflects agreement among specialists on best practices for this off-label use of ketamine.
bioRxiv (Cold Spring Harbor Laboratory)
February 10, 2026
Erdem Pulcu, Sara Costi, Pilar Artiach-Hortelano et al.
A single sub-anesthetic dose of ketamine reduces activity in the lateral habenula, a small midbrain structure involved in aversive learning, when healthy volunteers expect or experience unpleasant stimuli a day later. In a randomized trial with 70 adults, those who received ketamine showed attenuated habenula responses during an aversive Pavlovian conditioning task measured with 7-Tesla functional neuroimaging. Preliminary evidence suggests that reduced habenula activity during aversive learning may weaken the emotional impact of negative memories. These results support preclinical models of how ketamine may rapidly relieve depression by acting on the human habenula.