Ketamine as a Mental Health Treatment

Ketamine, initially approved as an anesthetic in 1970, is increasingly used off-label for treatment-resistant depression, anxiety, and posttraumatic stress disorder. Its S-enantiomer, esketamine (Spravato), received FDA approval for treatment-resistant depression in 2019. Clinical applications include intranasal esketamine, IV infusions, ketamine-assisted psychotherapy, and at-home therapy, with varying oversight. The regulatory landscape remains fragmented, evidence is evolving, and vulnerable patients seek relief. This article provides clinical information for nurses advising patients about ketamine and discusses regulatory, ethical, and nursing implications.

Study at a glance

Abstract

Ketamine has emerged as a promising intervention for treatment-resistant mental health disorders, such as depression, anxiety, and posttraumatic stress disorder. With rising global mental health burdens and the limitations of existing pharmacological treatments, ketamine's novel mechanism of action provides a potential alternative for individuals who have not responded to traditional therapies. Ketamine was initially approved by the U.S. Food and Drug Administration in 1970 for use as an anesthetic, and over the past two decades, has increasingly been investigated and used as an off-label treatment for mental health disorders. Additionally, the S-ketamine enantiomer of ketamine, esketamine (marketed as Spravato), received approval for treatment-resistant depression in 2019. Clinical applications of ketamine in the treatment of mental health disorders include intranasal administration (esketamine), IV infusions, ketamine-assisted psychotherapy, and at-home therapy, with varying levels of oversight. The current ketamine landscape has created a perfect storm in which the regulation of ketamine's use in mental health treatment remains fragmented, the evidence is constantly evolving, and a vulnerable population of individuals who are struggling with treatment-resistant mental health symptoms are desperate for relief. This article addresses these considerations by providing a foundation of clinical information that nurses should understand as they advise patients who are receiving, or curious about ketamine, as well as by discussing the regulatory, ethical, and nursing implications of using ketamine in the treatment of mental health disorders.