Ketamine for TRD: Do the Guidelines Follow the Science? A Systematized Review

Abstract

This systematized review will examine the data surrounding intravenous ketamine infusion therapy for the management of treatment-resistant depression (TRD) and will determine whether or not the therapy deserves reassessment within the standard treatment procedures. The 2022 Department of Veterans Affairs and Department of Defense (VA/DoD) guidelines for the management of Major Depressive Disorder state that ketamine or esketamine should be considered only for patients who have not responded to several adequate pharmacologic trials (‘trial’ referring to a standard form of treatment with a dose and time sufficient for response) and suggest them only as augmentations to existing regimens rather than stand-alone treatments (U.S. Department of Veterans Affairs, 2022). Therefore, this manuscript aims to examine the current placement of intravenous racemic ketamine in the care of TRD, the limitations of existing treatments, and the value of rapid antidepressant response in patients.

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