Patients and their caregivers may be interested in ketamine or esketamine (Spravato) treatment for treatment-resistant depression or anxiety. In future, other conditions may also prove to be amenable to treatment with these compounds.
Ketamine for depression should only be initiated by a psychiatrist after a full assessment. The route of administration, dose, and timing of doses depend on the way that the particular clinic works.
Only patients with treatment-resistant depression or anxiety are likely to be offered treatment with ketamine. Treatment resistance is defined in the literature as a trial of two different antidepressants, at an adequate dose for an adequate period of time. In practice, many psychiatrists would also offer a trial of an augmentation or combination strategy before considering ketamine.
Ketamine is contraindicated in patients with current substance misuse. The only exception to this is when ketamine is used in the course of treatment for drug addiction, usually in an inpatient setting. Treatment for substance misuse may well also be critical to a patient's recovery from depression and anxiety.
Patients with cardiovascular instability, cognitive impairment, or allergy to ketamine will not be suitable for treatment with ketamine in most cases.
Ketamine and esketamine require intensive assessment and follow up and are therefore costly treatments; esketamine in particular has a high per-dose cost, however it is possible that this medication may be partially subsidised for some patients.
The North Island's Ketamine clinic is through the NMDA Clinic in Tauranga. Please note that initial assessments can take place online via audiovisual link, but those moving forward with ketamine treatment will require an in-person titration appointment at the NMDA Clinic in Tauranga. Please email firstname.lastname@example.org for further information.
In the South Island, there are several trials underway in Dunedin, please see https://www.otago.ac.nz/dsm-psychmed/trials/index.html for further information.