Is Off-label repeat prescription of ketamine as a rapid antidepressant safe? Controversies, ethical concerns, and legal implications
BMC Medical Ethics January 14, 2016 Melvyn W. Zhang, Keith M. Harris, Roger Ho 69 citations
Ketamine, a dissociative anaesthetic and phencyclidine derivative with known abuse liability, has shown rapid antidepressant effects in some clinical trials for treatment-resistant depression, but methodological flaws and possible reporting bias may have influenced those findings. Regulatory agencies have not approved ketamine for depressive disorders, and a Canadian review did not recommend its prescription. Off-label repeat prescribing raises ethical concerns, especially given the comorbidity of substance abuse with depression and the lack of evidence ruling out long-term abuse risk. Two clinical vignettes illustrate ethical principles—autonomy, nonmaleficence, fidelity, and consequentialism—relevant to off-label ketamine use. Clinicians should exhaust standard antidepressant therapies before considering ketamine.