Question: I have suffered from depression for many years. What do you think of ketamine for med-resistant depression patients? I hear it can be very effective.

Dr. Hibberd's answer:
My initial response to this question would be to discourage this unless more conventional treatments, including a consideration of ECT (electroconvulsive therapy) have failed to induce remission. Treatment-resistant depression (TRD) is a relatively common condition, but is most often readily treated under professional guidance with the numerous drugs we now can use alone or in combination.
A report has suggested that improvement in treatment-resistant depressive symptoms occurred after 72 hours after ketamine infusion. Ketamine is an anaesthesia drug used most often in children to create amnesia in patients undergoing surgical procedures in the emergency department. Unfortunately, in adults, the recovery period may be accompanied by sometimes severe agitation and an "emergence phenomenon" may occur that if unrecognized may have frightening side effects. Treatment requires intravenous sedation and very close monitoring I'm afraid the improvement in depressive symptoms noted seems to last only for a short time.
Another case report has shown sustained remission of symptoms for a week following a short-course of repeated doses of ketamine. Repeated doses of intravenous ketamine have been claimed to be safe and efficacious in patients who continued to meet response criterion after six infusions. However, ketamine is an intravenous conscious sedation agent. It must be administered in a closely monitored facility with trained personnel who are familiar with conscious sedation requirements. Ketamine also has a high abuse potential, and a very transient response. I would suggest you discuss with your psychiatrist and your primary care physician whether all your options have been addressed. You will likely find it difficult to have ketamine infusion treatments covered by your health insurance unless conventional options have been exhausted, and it may not be a feasible option in your case.