Ketamine has been gaining attention as a potential treatment for depression, but researchers are cautioning against a widespread increase in its use. In a recent editorial in the New Zealand Medical Journal, experts from the University of Otago discussed the evolving use of ketamine in mental illness treatment in New Zealand.
While acknowledging that ketamine can offer significant short-term improvements for depression, the researchers emphasized the high relapse rates and potential for misuse associated with the drug. They recommend careful patient selection, close monitoring, and robust support structures to help manage these risks.
Ketamine is currently mainly used in research settings in New Zealand, although there is some limited use by publicly funded specialty services. Private providers have also begun to offer treatment with ketamine. Studies have shown that ketamine is associated with large short-term improvements in depression symptoms, but relapses can occur after treatment ends.
Dr. Ben Beaglehole, one of the authors of the editorial, highlighted the challenge of managing these relapses and expressed concerns about the abuse potential and adverse effects of ketamine, such as bladder issues and possible memory side effects.
While most ketamine used recreationally is produced offshore, there is a potential for misuse and diversion of prescribed ketamine for illicit use. Therefore, the researchers emphasize the need for careful patient selection and close monitoring for potential adverse outcomes.
The Royal Australian and New Zealand College of Psychiatrists recommends restricting the use of ketamine to treatment-resistant depression, outside of research settings. They also advise that its use should only occur in services where clinicians are familiar with the drug and support structures are in place.
Dr. Beaglehole suggests that specialty services are best equipped to initiate ketamine treatment for treatment-resistant depression, but attention to equity of access is crucial.
The potential benefits of ketamine in depression treatment are exciting, but the researchers urge caution based on lessons learned from past treatments. They emphasize the need to carefully consider the risks and benefits and to prioritize patients who are most likely to benefit from ketamine therapy.
In conclusion, while ketamine shows promise as a treatment for depression, its use should be approached with caution and limited to patients with treatment-resistant depression under the guidance of familiar clinicians. Close monitoring and support structures are essential in order to mitigate the risks associated with its use.