Ketamine in psychiatry: Ethical imperatives in harnessing a controversial yet promising therapy

Ketamine is a fast-acting treatment for psychiatric conditions that do not respond to other therapies, but its use is controversial. Evidence shows it can reduce depression, anxiety, and suicidal thoughts, yet it also carries risks such as dissociation, dependence, and unknown long-term effects. Its reputation as a recreational drug adds stigma and regulatory hurdles. The authors argue that ketamine should be accepted as a legitimate psychiatric treatment, but its use must be guided by ethical principles—autonomy, beneficence, non-maleficence, and justice—and supported by careful regulation and research, avoiding both unwarranted rejection and premature hype.

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Abstract

Ketamine has emerged as a rapid-acting intervention for treatment-resistant psychiatric disorders, generating both enthusiasm and unease. While evidence demonstrates robust antidepressant, anxiolytic and anti-suicidal effects, ketamine also carries risks, including dissociation, dependence and uncertain long-term safety. Its reputation as a recreational drug further complicates clinical adoption, fostering stigma and regulatory caution. In this article, we consider ketamine's psychiatric use through the lens of medical ethics, structured around the principles of autonomy, beneficence, non-maleficence and justice. We argue that while ketamine should be embraced as a legitimate psychiatric therapy, its application must be grounded in rigorous ethical practice, supported by regulation and research, and shielded from both undue dismissal and premature over-promotion.