Ketamine, traditionally used as an anesthetic, has emerged as a promising treatment for mood disorders like post-traumatic stress disorder (PTSD) and treatment-resistant depression. The drug has gained attention for its ability to provide rapid relief, often within hours, compared to traditional antidepressants, which can take weeks to show effects. However, new guidance from the American Society of Anesthesiologists (ASA) emphasizes the potential risks of ketamine, urging caution and careful oversight when using it for mental health treatment.
Ketamine’s Growing Popularity in Mental Health Treatment
Though not FDA-approved for non-anesthetic uses, ketamine has been increasingly prescribed off-label in clinics across the U.S. to treat conditions like depression and PTSD. The drug is usually administered via infusion or injection in a clinical setting, but some clinics are offering it through mail, encouraging patients to self-administer at home. This growing trend has raised concerns among healthcare professionals about the safety of unsupervised ketamine use, particularly when patients receive it outside of accredited clinics or medical settings.
The Risks of Unsupervised Ketamine Use
Ketamine, while effective for many patients, carries significant side effects, including high blood pressure, slowed breathing, and, in extreme cases, respiratory failure, cardiac issues, and seizures. For this reason, the ASA stresses that ketamine should only be prescribed and administered by trained healthcare professionals in controlled, monitored environments where necessary rescue equipment is readily available.
Dr. Donald E. Arnold, president of the ASA, highlights the importance of proper medical supervision: “People who have struggled with mental health issues and are understandably excited about a new treatment may not realize that they are risking their lives by receiving treatment without medical supervision in unaccredited clinics or offices without established safety standards.”
This concern is heightened following the tragic death of actor Matthew Perry, which was linked to the acute effects of ketamine use. The ASA’s guidance aims to increase awareness of the potential dangers of ketamine and stresses the importance of safe administration practices.
Guidance on the Safe Use of Ketamine
The ASA’s new guidance outlines strict recommendations for the use of ketamine outside of acute pain management or procedural sedation:
Prescribing and Administration: Ketamine should only be prescribed for a medical indication, as part of a comprehensive treatment plan, and administered by a licensed healthcare professional. It should be delivered in a monitored setting with appropriate rescue equipment readily available.
Therapeutic Goals: Ketamine treatment should have clear therapeutic endpoints, with a defined course of treatment.
Monitoring and Safety: Medical professionals should monitor patients throughout the treatment process with periodic face-to-face visits. They should also be vigilant for any signs of ketamine diversion for non-medical use.
Minimal Effective Doses: Ketamine should be prescribed at the lowest effective dose to minimize side effects and avoid excessive sedation, unconsciousness, or unresponsiveness, except in approved procedural settings.
Patient Education: Patients should be fully informed about the potential risks and side effects of ketamine therapy.
Collaboration Between Specialists
The ASA’s guidance emphasizes the collaboration between anesthesiologists and psychiatrists in exploring the potential of ketamine for mental health treatment. Dr. Arnold notes, “Anesthesiologists are working with psychiatrists via joint research, training programs, and other initiatives to advance mental health treatment using these drugs.”
For individuals considering ketamine for mental health purposes, the ASA advises consulting with a primary care physician or mental health professional to ensure the treatment is appropriate and safe.
Conclusion
While ketamine shows promise in treating mood disorders, its use outside of traditional anesthesia presents significant risks. The new guidance from the ASA underscores the importance of medical supervision, careful dosing, and patient education to ensure the safety and effectiveness of ketamine therapy. As the use of ketamine for mental health treatment continues to grow, proper medical oversight will be essential in maximizing its benefits while minimizing potential harm.
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