New Study Raises Questions About Ketamine for Depression

"I've had people I've worked with receive ketamine, seemingly with good benefit. However, it is often not a game changer in the way that I've seen many people respond to TMS. Unlike ketamine, which like psychedelic treatments and medication has a generalized effect on the brain, targeted TMS has continued to develop as we gain a more refined understanding of mechanisms of action and ways to enhance outcomes. We begin to approach true precision Interventional psychiatry."

"With ketamine, there's often an initial improvement that tapers off and almost always requires regular maintenance. I've also seen innumerable ketamine clinics pop up, often with a strong profit motive and sometimes dubious clinical oversight. Much of the ketamine treatment approach is based on idiosyncratic and not well researched approaches. We sometimes refer to it as the "wild, wild west". There are even mail order ketamine clinics which ship this potentially dangerous and addictive substance to your home with brief video consultations."

"An important study published in JAMA Psychiatry (2025) challenges some of the most popular narratives about ketamine's effectiveness as a rapid antidepressant, underscoring the crucial role of context and methodology in the evolving story of this treatment. Given how common depression is, and how difficult it has been to treat, it's understandable that promising treatments are met with great enthusiasm. However, great enthusiasm often is incompatible with critical thinking."

Popular narratives about ketamine's rapid antidepressant effectiveness are challenged, with context and methodology shown to critically determine outcomes. Depression is common and often difficult to treat, which fosters enthusiastic but sometimes uncritical adoption of new therapies. Precision interventional psychiatry remains in its infancy, while targeted transcranial magnetic stimulation (TMS) has advanced toward more precise, mechanism-informed treatment. Ketamine frequently yields an initial improvement that tapers and typically requires maintenance. The market has seen rapid proliferation of ketamine clinics, occasionally prioritizing profit over oversight, including mail-order models. Strong clinical oversight, comprehensive treatment planning, patient safety, and ethical care are essential.

Read at Psychology Today