Outpatient Ketamine Prescribing Practices in Psychiatry in the United States: A Nationwide Survey Study.

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.

Study at a glance

Abstract

Background: Ketamine is an increasingly popular tool for the treatment of psychiatric disorders. Initially available in controlled studies at academic institutions, it is now being offered widely in the community, but little is known about how treatment is actually being delivered and if there are undetermined safety concerns. The aim of this study is to assess ketamine prescribing practices among clinics across the United States. Methods: An online survey was sent to all community-based ketamine clinics with publicly available email addresses collected from 4 ketamine clinic databases (n = 484) between September and November 2023. Public ketamine clinic websites (n = 473) were also reviewed for information regarding the credentials of prescribers in June 2024. Results: A total of 126 (26% response rate) of the clinics responded to the survey request, and 119 were included in analyses. All included respondents (100%) report utilizing ketamine for treatment-resistant depression, with many also prescribing ketamine for treatment naive (72.3%), bipolar (78.9%), and subclinical depression (59.7%) in addition to nondepressive conditions at significant rates. Over 80% of clinics utilize maintenance ketamine treatment, with a substantial portion doing so for prolonged periods. A variety of ketamine formulations are regularly prescribed, and over 40% of clinics provide ketamine for at-home use. Based on website review, fewer than 30% of ketamine clinics reviewed are run by psychiatric physicians and over 25% are run by nonphysician providers. Conclusions: There is significant variability in ketamine treatment in the community including indications for therapy, duration of treatment courses, formulation of ketamine prescribed, and setting of use. There is a need for increased oversight and more specific practice guidelines to ensure ketamine is being used safely, appropriately, and effectively.