The Australian and New Zealand journal of psychiatry
October 1, 2024
Alistair Carroll, Adam Bayes, Mark Montebello et al.
10 citations
Ketamine is a restricted medication in Australia and New Zealand, with regulations that vary by jurisdiction and generally limit its use in patients who have a history of drug dependence. There is substantial variation in how drug dependence is defined legally and clinically, with clinical definitions from the ICD-11 and DSM-5. This paper reviews evidence on the risk of ketamine misuse and dependence among patients with a history of illicit drug use, abuse, or dependence, and offers recommendations for psychiatrists prescribing ketamine for treatment-resistant depression in this population.
The British journal of psychiatry : the journal of mental science
January 7, 2025
Natalie T Mills, Stevan Nikolin, Nick Glozier et al.
3 citations
Anxiety disorders and treatment-resistant major depressive disorder (TRD) often occur together. In a randomized controlled trial comparing subcutaneous ketamine to midazolam in 174 people with TRD, ketamine reduced anxiety only when given at flexible, response-guided doses (0.5-0.9 mg/kg). At a fixed low dose (0.5 mg/kg), the reduction in anxiety was not statistically significant. The anxiety-reducing effect was linked to overall depression improvement and was not sustained four weeks after treatment ended. The findings suggest that adequate dosing is necessary for ketamine's anxiolytic effect in this population.
Journal of affective disorders
October 15, 2025
Mary Lou Chatterton, Johana Kevin Perez, Thao Thai et al.
2 citations
Subcutaneous ketamine appears cost-effective for treatment-resistant depression from a health sector perspective when the costs of the control treatment (midazolam) are included, but not from a societal perspective. A cost-utility analysis alongside a randomized controlled trial with 174 participants compared ketamine to midazolam given twice weekly for four weeks. At the end of the trial, quality of life scores were significantly higher for ketamine. When control arm costs were included, ketamine was less costly and more effective, with an 89% probability of being cost-effective at a $50,000 per quality-adjusted life year threshold. Excluding those costs made ketamine not cost-effective, highlighting the importance of comparator choice.