A Pain Physician and Anesthesiologist’s Perspective on Ketamine for Treatment-Resistant Depression

Ketamine has emerged as a potential treatment for refractory depression. The clinical use of ketamine, however, has historically been confined to the field of anesthesiology. The majority of ketamine for affective disorder research has targeted psychiatrists. Expanded use of ketamine therapy will involve anesthesiologists, who possess a comprehensive understanding of its pharmacology. In this article, we provide a synthesis of past and current literature to provide a framework of the pharmacology, mechanisms, and clinical considerations for patient safety in the use of ketamine therapy for treatment-resistant depression. We caution support of indefinite administration of ketamine for depression due to lack of data on safety and efficacy with chronic use.