The American Journal of Nursing (AJN)Ketamine as a Mental Health Treatment

Ketamine has emerged as a rapid-acting treatment for treatment-resistant depression, PTSD, and anxiety, with symptom relief reported within 4–24 hours. With 33% of depression patients failing multiple medications, nurses across all settings will increasingly encounter patients seeking or receiving ketamine therapy.

⚖️ Clinical Considerations

• Only esketamine (Spravato) holds FDA approval for psychiatric use; all racemic ketamine prescriptions are off-label
• Contraindications include history of psychosis or mania, uncontrolled hypertension, active substance abuse, and pregnancy
• At-home ketamine carries significant misuse risk, as 55% of recipients took more than prescribed
• Benzodiazepines may dampen ketamine’s antidepressant effects and increase sedation

🎯 Practice Applications

• Screen patients for contraindications including psychiatric history, cardiovascular disease, and substance use
• Monitor vital signs throughout treatment; manage hypertension with metoprolol or clonidine as ordered
• Educate patients that only esketamine is FDA-approved; racemic ketamine use is off-label
• Assess for signs of misuse or diversion, particularly in patients receiving at-home prescriptions

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