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Lancet Psychiatry. 2017 May;4(5):419-426. doi: 10.1016/S2215-0366(17)30102-5. Epub 2017 Apr 5.

Ketamine treatment for depression: opportunities for clinical innovation and ethical foresight.

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Department of Psychiatry and Oxford Uehiro Centre, University of Oxford, Oxford, UK. Electronic address:
Department of Psychology, University of Exeter, Exeter, UK.
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
Centre for Neuropsychopharmacology, Division of Brain Sciences, Imperial College London, London, UK.
King's College London, London, UK.
Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.


We present a review and analysis of the ethical considerations in off-label ketamine use for severe, treatment-resistant depression. The analysis of ethical considerations is contextualised in an overview of the evidence for ketamine use in depression, and a review of the drug's safety profile. We find that, based on current evidence, ketamine use for severe, treatment-resistant depression does not violate ethical principles; however, clinicians and professional bodies must take steps to ensure that guidelines for good practice are enacted, that all experimental and trial data are made available through national registries, and that the risk potential of ketamine treatment continues to be monitored and modelled. We conclude with a set of key recommendations for oversight bodies that would support safe, effective, and ethical use of ketamine in depression.

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