http://worldcat.org/entity/work/id/2233619536

Intravenous ketamine for the treatment of mental health disorders : a review of clinical effectiveness and guidelines

Mental health disorders include anxiety, mood, and personality disorders. In any given year, one in five people in Canada experiences a mental health problem or illness, with a cost to the economy of well in excess of $50 billion. For the purposes of this paper, the focus will be on major depressive disorder (MDD), post-traumatic stress disorder (PTSD) and suicidal ideation. There are many issues with current pharmacotherapies used for mental health disorders. Some of these issues include the stigma of having a psychiatric illness, the side effects, and a perceived lack of response. A prior study in MDD patients found that roughly 30% of depressed patients discontinue medications within 30 days and more than 40% discontinue within 90 days making adherence a large issue. Clinical practice guidelines recommend a 6 to 12 month trial to adequately assess efficacy but due to these issues and a delayed onset of action, current pharmacotherapies are not an ideal in treatment option for acute and chronic episodes of mental health disorder. Ketamine emerged as a novel treatment for certain mental health disorders in 2000 when Berman et al. published a seven patient RCT of intravenous (IV) ketamine compared to a saline placebo showing a reduction in the Hamilton Depression Rating Scale (Ham-D). Given the lack of direction from major psychiatric associations, the utility of ketamine for certain mental health disorders is uncertain. The purpose of this report is to review the clinical effectiveness of intravenous ketamine for the treatment of depression, PTSD, and suicidal ideation, as well as the evidence-based guidelines for its use in these conditions.

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