During an engaging presentation at Psych Congress 2023 (September 6-10, 2023; Nashville, TN), David Dansky, MD, FACEP, provided an in-depth overview of the practical use of ketamine. He outlined numerous advantages of treating depression using ketamine compared to other antidepressants. He also addressed the topic of ketamine addiction and the importance of context in discussions about ketamine abuse.

 The advantages of using ketamine over other antidepressants are abundant. These include minimal drug interactions, a wide range of available doses, minimal cardiac effects, and transdiagnostic utility to treat other conditions. Out of the available antidepressant therapies, ketamine has very few interactions with other substances. The primary medications to avoid are benzodiazepines, lamotrigine, thyroid medications, opiates, and grapefruit juice. Due to the availability of several routes of administration—including intravenous (IV), intramuscular (IM), intranasal (IN), oral, and rectal— ketamine dosing is exceptionally titratable. Furthermore, studies on the cardiac effects of ketamine reveal no QT prolongation, no serotonin syndrome, minimal hypoxia, and decreased risk of aspiration.  Ketamine can treat many conditions, including post-traumatic stress disorder (PTSD), anxiety, premenstrual dysphoric disorder (PMDD), chronic pain, burn management, procedural sedation, and several others. Perhaps, most notably, ketamine has a striking effect on reducing suicidal ideations, sometimes within hours.  

An important consideration in the discussion was ketamine addiction. Fortunately, ketamine addiction is rare in medical practice. It is most prevalent in Southeast Asia and the United Kingdom. It also appears to depend on the route of administration to some degree. The most alarming observation surrounding ketamine abuse is the recent reports of ketamine being cut with fentanyl. Overdoses of ketamine have occurred only when mixed with fentanyl. No known cases of ‘purely’ ketamine overdose have been reported.

Overall, ketamine offers incredible benefits for the treatment of many debilitating conditions. News coverage on ketamine use has been wide-ranging, sometimes leading to a poor understanding of its potential. When considering the balance of advantages and risks of use, ketamine remains a valuable tool in a clinician’s toolbox.

Reference:
Dansky D. The practical use of ketamine. Presented at: Psych Congress; September 6-10, 2023; Nashville, TN.