Racemic Ketamine May Be Effective for the Treatment of Depression

Ben Medrano, MD, medical director, Field Trip Health, Toronto, Canada, and Michael J Verbora, MD, MBA, medical director, Field Trip Health, discuss what patient populations are benefiting most from intravenous (IV) ketamine treatment and what populations could be potentially harmed by the treatment. "I would say the bulk of the clients that we see are people with depression," says Dr Medrano. Medrano and Verbora explain that more evidence is needed to be confident in proceeding with personality disorder treatment with IV ketamine.

This discussion took place at the 2021 Psych Congress in San Antonio, Texas.

Read the transcript:

Dr Verbora: What patients do you find are benefiting most or who is most indicated for this type of treatment? 

Dr Medrano: Again, following the literature is our primary focus at Field Trip. Treatment-resistant depression is the main indication, at least if you consider it in light of Spravato's FDA-approval for ketamine for treatment-resistant depression. 

For all intents and purposes, racemic ketamine is essentially the same in terms of effect. There are some minor differences, but we found that racemic ketamine works just as well. Some people even argue that it may work even a little bit better, but I think we still have a ways to go with the literature. 

We do see other disorders that we treat. In particularly, there's some early literature for treatment of trauma with ketamine, very early literature for anxiety, OCD, and eating disorders, in particular, anorexia, I believe. At this point, I would say the bulk of the clients that we see are people with depression for the most part. 

Dr Verbora: That's great. Sounds like such a great option for a population that has typically been through so much in terms of the medical system, and who often are looking for hope. What type of patients do you find are not indicated for this therapy or could potentially be harmed by this type of approach? 

Dr Medrano: I think we're learning that in practice. We do know that it's contraindicated for people with a history of psychosis, mania, active mania that is. There's a little bit of debate around how to treat personality disorders with ketamine. 

I would say, right now, we need more evidence to be confident in proceeding with the treating of personality disorders, and very specifically, borderline personality disorder can be...In general, the diagnosis requires a good deal of attention. If you're in a clinic that is more of a short-term intervention, it's not a good option for borderline.