Ketamine has become a multibillion-dollar industry for mental health treatment in the USA, with three delivery models: in-person clinics offering off-label racemic ketamine, clinic visits for esketamine (Spravato), and telehealth services prescribing off-label racemic ketamine, the latter accounting for about half the market. The article describes legal changes enabling telehealth-only providers, differences in patient monitoring requirements, and implications for patient safety. Providers should evaluate whether sound evidence exists for off-label prescribing, whether benefits outweigh risks, and whether it serves the patient's best interests, noting that ketamine's dissociative properties raise concerns about appropriate prescribing under controlled substance laws.
A 4-week therapist-assisted mindfulness-based stress reduction (MBSR) program was not superior to a minimal self-guided mindfulness-based intervention (MBI) for improving mental health among frontline healthcare workers during the COVID-19 pandemic. In a randomized trial with 201 participants, both interventions led to similar, significant reductions in depressive, anxiety, and somatic symptoms from baseline to 6-month follow-up (Cohen's d -0.78 for MBSR, -0.72 for self-guided MBI). The therapist-assisted MBSR showed a greater reduction in symptoms immediately after the intervention and exclusively increased posttraumatic growth at that point. Both approaches improved posttraumatic symptoms, insomnia, repetitive negative thinking, mental well-being, mindfulness, and self-compassion.