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. 2023 Oct 13;9(6):e191.
doi: 10.1192/bjo.2023.577.

Multidisciplinary development of guidelines for ketamine treatment for treatment-resistant major depression disorder for use by adult specialist mental health services in New Zealand

Ben Beaglehole  1 , Paul Glue  1 , Mike Clarke  2 , Richard Porter  1
Affiliations

Multidisciplinary development of guidelines for ketamine treatment for treatment-resistant major depression disorder for use by adult specialist mental health services in New Zealand

Ben Beaglehole et al. BJPsych Open. .

Abstract

Background: The evidence base for racemic ketamine treatment for treatment-resistant major depressive disorder (TRD) continues to expand, but there are major challenges translating this evidence base into routine clinical care.

Aim: To prepare guidelines for ketamine treatment of TRD that are suitable for routine use by publicly funded specialist mental health services.

Method: We consulted with senior leadership, clinical pharmacy, psychiatrists, nursing, service users and Māori mental health workers on issues relating to ketamine treatment. We prepared treatment guidelines taking the evidence base for ketamine treatment and the consultation into account.

Results: Ketamine treatment guidance is reported. This offers two treatment pathways, including a test of ketamine responsiveness with intramuscular ketamine and the dominant use of oral ketamine for a 3-month course to maximise the opportunity for the short-term benefits of ketamine to accumulate.

Conclusions: We have responded to the challenges of translating the evidence base for ketamine treatment into a form suitable for routine care.

Keywords: Ketamine; evidence base; guidelines; oral ketamine; protocol.

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Conflict of interest statement

B.B. is actively researching ketamine treatment for mood and anxiety disorders. P.G. has a research contract with Douglas Pharmaceuticals to develop novel oral ketamine formulations. He has also attended advisory boards for Janssen Pharmaceuticals. M.C. has no conflicts of interest to declare. R.P. has made use of computer software at no cost for research – provided by SBT-pro; received support for travel to educational meetings from Servier and Lundbeck; and is a Deputy Editor for BJPsych Open but did not take part in the review or decision-making process for this paper.

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