Who Should Administer Ketamine Treatment?

Research is Recognizing More Uses for Ketamine Treatment

In a 2017 paper “Considerations on the Off-Label Use of Ketamine as a Treatment for Mood Disorders” the authors Samuel T. Wilkinson, MD and Gerard Anancora, MD, PhD note that an increasing number of small clinical trials is proving the efficacy of the drug Ketamine for helping patients with severe or chronic depression.  Ketamine therapy is being increasingly prescribed for individuals who previously have not responded to standard anti-depressant medications. As an FDA approved drug since the 1960s, Ketamine is also used for anesthesia in surgical settings.

In a 2017 study examining the effects of Ketamine treatment for older patients, Professor Colleen Loo noted “robust antidepressant effects after a single dose of subanesthetic Ketamine.”  Other researchers, including Timothy Lineberry, M.D., a Mayo Clinic Psychiatrist have noted Ketamine’s promise.  In a discussion of a Mayo Clinic study, Lineberry noted how well and quickly Ketamine appeared to work.

As Ketamine treatment gains favor, the medical community is focusing on the issue of what qualifications should be required for physicians who administer the treatments.  Subanesthetic doses of Ketamine can induce potentially dangerous elevations in heart rate and blood pressure.  Because of these potential side effects, the authors note that it is important to develop administrative standards for Ketamine therapy.

Baseline Standards for Ketamine Administration

The same 2017 paper from Samuel T. Wilkinson, MD and Gerard Anancora, MD, PhD suggested that physicians who administer Ketamine should at a minimum be prepared to deal with cardiac and behavioral events that can arise in the interval (30-120 minutes) following the cessation of the treatment.  There is also a growing consensus that physicians should have training in advanced cardiac life support techniques.  The treatment center itself should also be equipped to provide cardiovascular and respiratory monitoring.

Psychiatrists for Subanasthetic Ketamine and Anesthesiologists for Anesthetic Ketamine

For patient safety, the medical community is moving towards a consensus that would require Ketamine physicians to be licensed Drug Enforcement Agency Schedule III medications.  In most states, this standard would require the administrator to hold an MD.

Following this train of thought, since ketamine therapy is growing as a treatment option for treatment-resistant depression and other psychiatric indications, it is highly advisable that a Psychiatrist is involved in both the assessment and treatment of these patients.  For anesthetic dosing of Ketamine, it would follow that an anesthesiologist be consulted.

In general for Ketamine treatment, the Yale authors recommend creating the following protocols:

  • An assessment of vital signs
  • Confirmation of preprocedural informed consent
  • Developing criteria for accepting baseline vital signs prior to initiating treatment
  • Developing criteria for prematurely stopping an infusion

As research continues to show that ketamine is beneficial for people with psychiatric conditions, it is increasingly important to consider who should be administering treatment.

Amanda Itzkoff, MD is pleased to offer ketamine treatment as an option for suitable candidates at her psychiatric practice. For general information, please feel free to email our office at Amanda.Itzkoff@gmail.com. To schedule an appointment, call our offices at 917-609-4990.

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