Demystifying Ketamine: A Guideline Based Treatment for Depression

Presenting Author(s): Dr. Carson Chrenek, Dr. Atul Khullar, MDD, Dr. Jennifer Swainson, MD, FRCPC

Date and time: 22 Mar 2025 from 13:00 to 14:00

Location: Hawthorn B  

Abstract

Non -IV forms of Ketamine are now recognized by the CANMAT 2023 Depression(1) guidelines as 3rd line adjuncts for depression and there is a plethora of patients with an excellent response but this treatment is still not accessible to most. The current landscape of Ketamine treatment in Alberta (and Canada) consists of multiple treatment models including public and private IV ketamine programs, private clinics offering observed IM, IN or PO ketamine pharmacotherapy, private clinics offering ketamine assisted psychotherapy (KAP)(2). and ketamine pharmacotherapy prescribed for home use. The existence of these multiple models contributes to significant confusion about requirements for prescribing ketamine and/or safety of its use among patients and physicians, creating a tiered access and misinformation about treatments.

This workshop will clarify treatment models and provide a framework for the general psychiatrist to determine when home ketamine use may be appropriate. The CPSA and Alberta government requirements for ketamine prescribing or ketamine psychotherapy will be reviewed. Safety issues such as patient selection, the level or need for monitoring during treatment and abuse potential will be addressed. Contrast and context with other guideline supported off label treatments for mood disorders will be given. Practical recommendations on “how to” safely incorporate ketamine prescribing into general psychiatric practice will be discussed including pre ketamine workup, patient education, informed consent, dose ranges, and patient follow-up(3).

Learning Objectives

1. Review guideline supported evidence for ketamine as an adjunct for depression;

2.Describe treatment models using ketamine for depression; and

3.Review considerations for home and observed ketamine use and discuss “how to” incorporate ketamine in general psychiatric practice.

Literature References

1. Lam RW, Kennedy SH, Adams C, Bahji A, Beaulieu S, Bhat V, Blier P, Blumberger DM, Brietzke E, Chakrabarty T, Do A, Frey BN, Giacobbe P, Gratzer D, Grigoriadis S, Habert J, Ishrat Husain M, Ismail Z, McGirr A, McIntyre RS, Michalak EE, Müller DJ, Parikh SV, Quilty LS, Ravindran AV, Ravindran N, Renaud J, Rosenblat JD, Samaan Z, Saraf G, Schade K, Schaffer A, Sinyor M, Soares CN, Swainson J, Taylor VH, Tourjman SV, Uher R, van Ameringen M, Vazquez G, Vigod S, Voineskos D, Yatham LN, Milev RV. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults: Réseau canadien pour les traitements de l'humeur et de l'anxiété (CANMAT) 2023 : Mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes. Can J Psychiatry. 2024 Sep;69(9):641-687. doi: 10.1177/07067437241245384. Epub 2024 May 6. PMID: 38711351; PMCID: PMC11351064.

2. Chrenek C, Duong B, Khullar A, McRee C, Thomas R, Swainson J. Use of ketamine for treatment resistant depression: updated review of literature and practical applications to a community ketamine program in Edmonton, Alberta, Canada. Front Psychiatry. 2024 Jan 8;14:1283733. doi: 10.3389/fpsyt.2023.1283733. PMID: 38260793; PMCID: PMC10801061.

3.Kew BM, Porter RJ, Douglas KM, Glue P, Mentzel CL, Beaglehole B. Ketamine and psychotherapy for the treatment of psychiatric disorders: systematic review. BJPsych Open. 2023 May 2;9(3):e79. doi: 10.1192/bjo.2023.53. PMID: 37128856; PMCID: PMC10228275.