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. 2022 Sep 29:13:1017504.
doi: 10.3389/fpsyt.2022.1017504. eCollection 2022.

Intravenous ketamine for depression: A clinical discussion reconsidering best practices in acute hypertension management

Ryan Yip  1 , Jennifer Swainson  2   3 , Atul Khullar  2   4   5 , Roger S McIntyre  6   7   8   9 , Kevin Skoblenick  1   10   11
Affiliations

Intravenous ketamine for depression: A clinical discussion reconsidering best practices in acute hypertension management

Ryan Yip et al. Front Psychiatry. .

Abstract

Ketamine is a versatile medication with an emerging role for the treatment of numerous psychiatric conditions, including treatment resistant depression. Current psychiatry guidelines for its intravenous administration to treat depression recommend regular blood pressure monitoring and an aggressive approach to potential transient hypertensive episodes induced by ketamine infusions. While this approach is aimed at ensuring patient safety, it should be updated to align with best practice guidelines in the management of hypertension. This review defines and summarizes the currently recommended approach to the hypertensive emergency, the asymptomatic hypertensive urgency, and discusses their relevance to intravenous ketamine therapy. With an updated protocol informed by these best practice guidelines, ketamine treatment for depression may be more accessible to facilitate psychiatric treatment.

Keywords: hypertension; hypertensive emergency; ketamine; ketamine infusion; treatment resistant depression.

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Conflict of interest statement

Author AK has received speaker/consultation fees from Lundbeck, Elvium, Pfizer, Otsuka, Takeda, Sunovion, Bausch Health, Novo Nordisk, Eisai, Jazz, Paladin, the Newly Institute and Abbvie. Author RM has received research grant support from CIHR/GACD/National Natural Science Foundation of China (NSFC) and the Milken Institute; speaker/consultation fees from Lundbeck, Janssen, Alkermes,Neumora Therapeutics, Boehringer Ingelheim, Sage, Biogen, Mitsubishi Tanabe, Purdue, Pfizer, Otsuka, Takeda, Neurocrine, Sunovion, Bausch Health, Axsome, Novo Nordisk, Kris, Sanofi, Eisai, Intra-Cellular, NewBridge Pharmaceuticals, Viatris, Abbvie, Atai Life Sciences and also he is a CEO of Braxia Scientific Corp. Author JS has received speaker/consultation fees from Abbvie, Eisai, Lundbeck, Bausch Health, Janssen, and serves as a medical advisor for the Newly Institute. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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References

    1. Swainson J, McGirr A, Blier P, Brietzke E, Richard-Devantoy S, Ravindran N, et al. . The Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Recommendations for the Use of Racemic Ketamine in Adults with Major Depressive Disorder: Recommandations Du Groupe De Travail Du Reseau Canadien Pour Les Traitements De L'humeur Et De L'anxiete (Canmat) Concernant L'utilisation De La Ketamine Racemique Chez Les Adultes Souffrant De Trouble Depressif Majeur. Can J Psychiatry. (2021) 66:113–25. 10.1177/0706743720970860 - DOI - PMC - PubMed
    1. Andrade C. Ketamine for depression, 4: In what dose, at what rate, by what route, for how long, and at what frequency? J Clin Psychiatry. (2017) 78:e852–e7. 10.4088/JCP.17f11738 - DOI - PubMed
    1. Kraus C, Rabl U, Vanicek T, Carlberg L, Popovic A, Spies M, et al. . Administration of ketamine for unipolar and bipolar depression. Int J Psychiatry Clin Pract. (2017) 21:2–12. 10.1080/13651501.2016.1254802 - DOI - PubMed
    1. Sanacora G, Frye MA, McDonald W, Mathew SJ, Turner MS, Schatzberg AF, et al. . A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA Psychiatry. (2017) 74:399–405. 10.1001/jamapsychiatry.2017.0080 - DOI - PubMed
    1. McIntyre RS, Rosenblat JD, Nemeroff CB, Sanacora G, Murrough JW, Berk M, et al. . Synthesizing the evidence for ketamine and esketamine in treatment-resistant depression: an international expert opinion on the available evidence and implementation. Am J Psychiatry. (2021) 178:383–99. 10.1176/appi.ajp.2020.20081251 - DOI - PMC - PubMed

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