In patients with treatment-resistant depression, intravenous ketamine appears safe regarding dissociative and psychotic symptoms, but those with epilepsy require close monitoring. Among 49 inpatients with major depressive or bipolar disorder and somatic comorbidities, psychotic symptom scores changed significantly over time only in the epilepsy subgroup. For other somatic conditions, no significant psychotic symptom changes occurred regardless of depression diagnosis. The study was small, unblinded, and limited to a single site, so findings are preliminary.
In hospitalized patients with treatment-resistant depression (major depressive or bipolar disorder), intravenous ketamine treatment was associated with changes in psychotic symptoms over time among those with epilepsy, but not among those with other somatic conditions. The study, which included 49 participants and was limited by a small, unblinded, single-site design, suggests that careful monitoring for psychotic symptoms is needed when using ketamine in patients with epilepsy, and that somatic comorbidities may influence dissociative side effects.