A growing number of small but highly consistent controlled trials, case series, and anecdotal reports have demonstrated ketamine’s rapid and robust transient antidepressant properties. A meta-analysis of the published studies recently completed by the American Psychiatric Association Council of Research Task Force on Novel Biomarkers and Treatments found the data from these studies to provide ‘compelling evidence that the antidepressant effects of ketamine infusion are both rapid and robust, albeit transient.’ (Newport et al, 2015). Although there are few reports examining the efficacy of repeated ketamine administration, those that have been published suggest the initial antidepressant effect can be extended over several weeks with repeated administrations (Murrough et al, 2013; Singh et al, 2016). Accounts of these findings have generated great interest in the media and optimism among patients. This has led to a growing number of clinics and practitioners who are now offering various forms of ketamine treatment for mood and anxiety disorders throughout the United States, and a growing advocacy network that promotes the accessibility of the treatment (ketamineadvocacynetwork.org).

However, there is concern by some that the enthusiasm engendered by these reports combined with the desperate plight of the patients and their families may be leading to use of ketamine in ways that are not yet adequately supported by the existing evidence. Although there is strong evidence that treatment with ketamine can provide significant short-term benefits to a large proportion of individuals suffering from serious, disabling and potentially fatal mood disorders, the treatment has not yet undergone the test of larger-scale clinical trials to demonstrate the durability and safety of long-term treatment. Neither has the treatment approach been subjected to the scrutiny of a US FDA review. In addition, the growing abuse of ketamine in Asia and other areas of the world (Advisory Council on the Misuse of Drugs) has raised significant concerns over the potential for fostering substance use disorders and drug diversion through the broader use of ketamine in the treatment of depression. Consequently, the medical field is now somewhat at odds over the expanding off-label use of ketamine in the treatment of mood disorders.

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