Ketamine for Treatment-Resistant Depression

OBJECTIVE: This discussion paper provides psychiatric nurses with a comprehensive, balanced review of the current evidence on the use of ketamine for treatment-resistant depression (TRD), including its mechanisms of action, clinical indications, administration, and key clinical considerations. METHODS: Recent clinical evidence on ketamine use for TRD is reviewed in this discussion paper. RESULTS: Current evidence indicates that among adults with TRD receiving psychiatric care, ketamine can produce rapid, clinically meaningful antidepressant effects, with an estimated number needed to treat (NNT) of 3 within 1 day to 1 week following treatment and 9 at 4 weeks. Evidence also suggests that ketamine is noninferior to electroconvulsive therapy (ECT), a well-established and highly effective treatment for severe depression and TRD. Compared with ECT, ketamine has also been associated with fewer memory-related adverse effects and a lower overall adverse-event rate (25% vs. 32%). Together, these findings support the potential role of ketamine in psychiatric practice when accompanied by appropriate patient assessment, monitoring, and follow-up. CONCLUSION: It is imperative that clinicians remain informed about emerging treatments for TRD and maintain open, informed dialogue with patients about its therapeutic potential.