Future of C-L Psychiatry
Ketamine is a robust and rapid antidepressant studied for treatment resistant depression. Off-label use of ketamine for depression has become commonplace in many areas of the country, and the s-enantiomer of ketamine (esketamine) was recently FDA-approved as an intranasal spray for patients with treatment resistant depression. It is anticipated that esketamine will also soon be reviewed by the FDA as a treatment for acute suicidal ideation in the setting of depression. Prior to the excitement around ketamine treatment for depression, for decades ketamine has been in use as an anesthetic agent and as a treatment for pain. It is also recreationally abused. As can be inferred from these various uses, there are many potential benefits and limitations of its use in clinical practice.
This symposium will focus on how ketamine works mechanistically, the efficacy of ketamine for depression and for pain, and how and when ketamine may be appropriately utilized in clinical practice. There will be a special focus on the potential role of ketamine in the treatment of medically ill patients. Dr. Kruse will review the evidence regarding mechanisms of ketamine’s antidepressant effect, as well as the literature to date on the efficacy of ketamine for the treatment of depression. She will review pragmatic considerations and approaches to the clinical use of ketamine (and esketamine), including potential risks and benefits, as well as appropriate patient selection. Dr. Irwin will review evidence for the use of ketamine for depression in palliative care settings, and Dr. Strouse will review the evidence for use of ketamine as a treatment for pain. This will be followed by a question and answer session.