PsychiatryOnline | American Journal of Psychiatry | A Word to the Wise About Ketamine

Recent reports of an acute antidepressant effect for intravenous
ketamine, a schedule III agent used in anesthesia and pain clinics, have
generated considerable hope and enthusiasm among both researchers and
clinicians .
The response partly reflects hope that a new mechanism of
antidepressant action has been discovered and highlights the scarcity of
agents that clinicians can administer to produce immediate effects on
mood. Positive initial research reports
have unintentionally engendered growing off-label clinical use of
ketamine in emergency rooms, specialty pain clinics and, most recently,
free-standing private psychiatry clinics. If ketamine were a new drug,
then the Food and Drug Administration would have required hundreds more
patients to be rigorously studied before an approval for general
distribution. However, because ketamine was already approved as an
anesthetic, any physician can legally prescribe it. Some practitioners
have even commissioned pharmacists to compound intranasal and other
formulations. This unbridled enthusiasm needs to be tempered by a more
rational and guarded perspective.