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Developing an IV Ketamine Clinic for Treatment-Resistant Depression: a Primer.
Sagar V Parikh1, Daniela Lopez1, Jennifer L Vande Voort1
1Parikh, MD, Lopez, MS, Maixner, MD, Watson, MD, Drake, MD, Bio-K Study Team, Department of Psychiatry and Depression Center, University of Michigan, Ann Arbor, Michigan. Voort, MD, Rico, MBA, Singh, MD, Frye, MD, Bobo, MD, Bio-K Study Team, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota. Achtyes, MD, Bio-K Study Team, Pine Rest Christian Mental Health Services, Grand Rapids, Michigan. Coryell, MD, Bio-K Study Team, University of Iowa, Iowa City, Iowa. Goddard, MD, Bio-K Study Team, University of California San Francisco, San Francisco, California. Goes, MD, Bio-K Study Team, Department of Psychiatry and Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Riva-Posse, MD, Bio-K Study Team, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia. Tarnal, MD, Bio-K Study Team, Department of Anesthesiology, University of Michigan, Ann Arbor. Greden, MD, Bio-K Study Team, Department of Psychiatry and Depression Center, University of Michigan, Ann Arbor, Michigan; National Network of Depression Centers, Ann Arbor, Michigan. Kaplin, MD, Bio-K Study Team, Department of Psychiatry and Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; MyMD Pharmaceuticals Inc, Baltimore, Maryland.
Subanesthetic intravenous ketamine shows promise for treatment-resistant depression (TRD), but clinics need careful planning. This review outlines key considerations for safe and effective ketamine clinic implementation.
Area of Science:
- Psychiatry
- Pharmacology
- Health Systems Management
Background:
- Subanesthetic intravenous ketamine is increasingly used for treatment-resistant depression (TRD).
- Ketamine is FDA-approved for anesthesia but not yet for psychiatric indications, raising safety and efficacy concerns.
- The rapid growth of ketamine clinics necessitates structured guidelines for safe implementation.
Purpose of the Study:
- To review key challenges and propose approaches for developing and implementing ketamine clinics.
- To provide a framework addressing systems, provider, and patient domains for ketamine infusion services.
- To ensure the safe and effective delivery of ketamine for depression treatment.
Main Methods:
- A review of challenges and potential solutions for ketamine clinics.
- Framework development encompassing systems, provider, and patient domains.
- Identification of standard operating procedures for clinic operations.
Main Results:
- Systems domain: Emphasizes stakeholder engagement, business case development, and administrative SOPs.
- Provider domain: Outlines treatment team roles and training requirements.
- Patient domain: Details patient assessment, dosing, administration, and safety monitoring SOPs.
Conclusions:
- Developing a ketamine clinic requires addressing systems, provider, and patient factors.
- Standardized protocols are crucial for safe ketamine administration and patient monitoring.
- This review offers essential considerations for meeting the demand for ketamine treatment while ensuring patient safety.
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