Many women who could become pregnant receive ketamine for psychiatric conditions, but risks to a developing fetus are frequently overlooked. A survey of U.S. outpatient ketamine clinics found that fewer than half discuss pregnancy-related risks during informed consent, only 20% require pregnancy tests before treatment, and just 13.7% recommend or require contraception. A record review at one academic medical center showed all patients were tested weekly for pregnancy, but only half used contraception. The findings indicate a need for greater attention to reproductive health in ketamine treatment protocols.
Ketamine is increasingly used for psychiatric disorders outside academic settings, but little is known about real-world practices. A survey of U.S. community-based ketamine clinics and a review of their websites found that all clinics use ketamine for treatment-resistant depression, and many also prescribe it for treatment-naive depression (72.3%), bipolar depression (78.9%), and subclinical depression (59.7%). Over 80% of clinics offer maintenance treatment, often for prolonged periods, and over 40% provide ketamine for at-home use. Fewer than 30% of clinics are run by psychiatric physicians, and over 25% by nonphysician providers. The findings indicate significant variability in indications, duration, formulations, and settings, highlighting a need for increased oversight and specific practice guidelines.