Key Considerations for Practical Administration of Ketamine in Severe Depression, and Its Use in Community Care in Edmonton, AB, Canada

Access to effective ketamine treatments for treatment-resistant depression is limited by cost, availability, and monitoring requirements. This article synthesizes current literature on ketamine's pharmacology and describes its application in a clinical program in Edmonton, Alberta. Topics include the rationale for maintenance treatments, monitoring long-term safety, and alternative options such as sublingual or at-home ketamine to improve patient access. The authors review considerations for cautious prescribing outside highly monitored settings.

Study at a glance

Abstract

Although both intranasal esketamine and intravenous ketamine have proven efficacy and tolerability in treatment-resistant depression (TRD), patient access to these treatments is often limited due to cost, availability, and/or monitoring requirements. This article is intended to provide a synthesis of the current literature with regard to the pharmacologic use of ketamine in TRD and describe its application to clinical programming in Edmonton, AB, Canada. Topics discussed include rationale for maintenance ketamine treatments, monitoring of long-term safety concerns, and alternative options to intranasal esketamine and intravenous ketamine as creative solutions to improve patient access. Considerations for cautious and judicious prescribing of ketamine outside of highly monitored clinical settings are reviewed.