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Review
. 2024 Oct;58(10):831-838.
doi: 10.1177/00048674241242315. Epub 2024 Apr 1.

Drug dependence and prescribing ketamine for treatment-resistant depression in Australia and New Zealand

Alistair Carroll  1   2 , Adam Bayes  1   2 , Mark Montebello  3   4   5 , Jonathan Brett  6   7   8   9 , Shalini Arunogiri  10   11 , John B Saunders  12 , Colleen K Loo  1   2   13
Affiliations
Review

Drug dependence and prescribing ketamine for treatment-resistant depression in Australia and New Zealand

Alistair Carroll et al. Aust N Z J Psychiatry. 2024 Oct.

Abstract

Ketamine is a restricted and regulated medication in Australia and New Zealand, which has implications when considering treatment for patients with treatment-resistant depression and a history of illicit drug use, abuse or dependence. Regulations governing prescription of ketamine for treatment-resistant depression vary between jurisdictions in Australia and New Zealand, though most restrict use in those with drug dependence. There is substantial variation in definitions of drug dependence used in each jurisdiction, and between the legal and clinical definitions, with the latter specified in the current International Classification of Diseases, Eleventh Revision and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. This paper reviews the literature assessing the risk of ketamine misuse and dependence in patients with a history of illicit drug use, abuse or dependence and presents recommendations for psychiatrists who prescribe ketamine in such patients with treatment-resistant depression.

Keywords: Ketamine; depression; drug dependence; regulations.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: A.C. has none to declare with respect to this work. A.B. set up Spravato early access programme at BDI, and involved in ketamine treatment programme at BDI. M.M. has been an advisory board member for AbbVie Australia and Pfizer Australia, both unrelated to this project. J.B. has none to declare with respect to this work. S.A. has none to declare with respect to this work, and other disclosures are as follows: she has received speaker honoraria from Gilead, Janssen, Indivior and Camurus unrelated to this work. J.B.S. was a member of the WHO Expert Committee on Drug Dependence in 2012 and 2014 which adjudicated on ketamine as a drug of abuse. Note that the Committee had a global orientation (in Australia ketamine was barely used as an human anaesthetic) and this was before its value in TRD was known. He has no other disclosures or conflicts of interest to declare. C.K.L. has received competitive research grant funding from the Australian NHMRC and MRFF to conduct clinical trials on ketamine in TRD, and has served as an advisory board member for Janssen and Douglas Pharmaceuticals, which manufacture formulations of ketamine.

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