Development of the primary care/psychiatry collaborative ketamine clinic for treatment-resistant depression

摘要

Patients with treatment-resistant depression (TRD) have limited treatment options. Subanesthetic doses of ketamine have been shown to have rapid and sustained antidepressant effect in some patients with TRD. Both the intravenous and intramuscular ketamine treatments administered in a clinical setting, where the dose, frequency, and patients’ response can be monitored by the clinical staff, provide safe and effective treatment. The availability of intramuscular ketamine allows the expansion of TRD treatments to the primary care settings, especially in rural communities where access to specialized treatment modalities is limited. This report focuses on ketamine treatment of TRD using a collaborative and consultative approach between psychiatry and primary care and describes a clinical protocol for ketamine treatment for TRD in this setting.