The drug ketamine—known as “special K” to those who appreciate its recreational uses—is an anesthetic that may have promise as an antidepressant. At the least, ketamine may be succeeded by similar drugs, that is, drugs that have the same mechanism of action (blocking NMDA receptors) but avoid ketamine’s side effects, which include hallucinations. Other potential improvements include more convenient dosing and delivery. Although pharma is making progress, as evidenced by the recent success of the ketamine cousin GLYX-13, the industry is not moving fast enough to satisfy the severely depressed who do not respond to conventional antidepressants, which boost neurotransmitter levels. Severely depressed patients are already being treated with ketamine, outside of clinical trials, on an off-label basis. But do the potential benefits outweigh the risks?
In the near term, what is the best way to use ketamine in treating depression?
Just say no! Ketamine poses too many problems—so many, in fact, that a clinical trial is unwarranted.
Ketamine could be useful, but its use as an antidepressant should be severely limited, at least until a clinical trial can be conducted.
Compassionate care is appropriate for desperate patients who are not helped by conventional antidepressants.
The decision is entirely up to the doctor and the patient, whether or not the patient has exhausted conventional options.