Research Article - (2025) Volume 10, Issue 3
Overview of Ketamine Guidelines in Psychiatric Disorders
2psychiatrist and addiction treatment, Resident Doctor, Ain Shams University (ASU), Egypt
Received Date: Aug 25, 2025 / Accepted Date: Sep 22, 2025 / Published Date: Sep 26, 2025
Copyright: ©2025 Hesham Maged Mohamed Abdelfatah, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Citation: Abdelfatah, H. M. M., Gomaa, M. M. (2025). Overview of Ketamine Guidelines in Psychiatric Disorders. Int J Psychiatry, 10(3), 01-04.
Abstract
Ketamine has anti depressive characters and approved by (FDA) for the induction and maintenance of anesthesia, Ketamine has been incorporated into the management of psychiatric disorders, such as Major Depressive Disorder (MDD) especially with suicidal ideation or attempting, and of label in management of Bipolar Disorder, Post-Traumatic Stress Disorder (PTSD), Obsessive-Compulsive Disorder (OCD), Substance Use Disorders (SUD).Intravenous ketamine regimen is not a first-line management for psychiatric disorders and considered by the patient’s interdisciplinary team work after failure of standard treatment. Ketamine mechanism of action is different from existing treatments and has demonstrated efficacy in improving people with Major Depression Disorder where conventional first line management as antidepressants, psychotherapy, have not be fully effective. In this paper we discussed all aspects of ketamine Protocol and guidelines usages in psychiatric.
Keywords
Ketamine Infusion, Suicide Ideation, ECT, Depression, PTSD, OCD, Substance Abuse, Bipolar Disorder, Alcohol Abused
Discussion
What is Ketamine?
Ketamine is a dissociative anesthetic agent, a compound that induces a state of dissociation between the mind and body of patient. It provides multiple levels of anesthesia, from decreased consciousness but awake to fully unconsciousness, hence why ketamine is used as anesthetic agent. The stage between awake and deeply anesthetic, known as dissociation results in a level of awareness like when we are dreaming.
Figure 1: Ketamine Structure and its Effects
Background
Ketamine is an NMDA receptor antagonist with a power anesthetic effect. It was developed in 1963 as a replacement for phencyclidine (PCP) by Calvin Stevens at Parke Davis Laboratories. Ketamine started being used for veterinary aspects in Belgium and in 1964 was founded that compared to PCP, it produced minor hallucinogenic characters and shorter psychotomimetic actions. It was approved by FDA in 1970, and from there, it has been used as an anesthetic for children or patients undergoing minor operation.
Ketamine Mechanism of Action
In depression and at low doses ketamine is preferentially bind to and inhibit N-methyl-d-aspartate receptors (NMDARs) on γ- aminobutyric acid (GABA) ergic interneurons. This leading to reduced excitability of these inhibitory interneurons, which causes disinhibition of glutamatergic neurons. With increased depolarization of the presynaptic neuron leads to a surge of glutamate release.
Figure 2: Ketamine Mechanism of Action
Indications of Treatment with Ketamine
Contraindications of Ketamine Therapy
Frequency of Treatment of Ketamine Therapy
weekly regimen within the Ketamine with a maximum of 6 sessions for the acute phase of treatment. Then this will continue at an extended time for maintenance, weekly, fortnightly etc. The frequency may be Adjustment with patient as needs, Response rates in controlled trials have ranged from (25% to 85% at 24 hours post infusion) and from (14% to 70%) at 72 hours post infusion). A weekly assessment and evaluation is done with a planned further infusion fortnightly extended to 3 weekly that depending upon patient responses.
Obtaining Consent
Before starting treatment with Ketamine obtaining informed consent is the responsibility of the Consultant Psychiatrist for Ketamine therapy, and the patients known the all details of guidance of ketamine therapy and he approved and accepted.
Advice to Patients
Prescribing Ketamine
This will be the responsibility of the Anesthetist in consultation with Consultant Psychiatrist. Ketamine will be prescribed on the inpatient Hospitals not in private clinic's.
Administration of Ketamine
Ketamine will be used as a single sub-anesthetic intravenous dose at (500 micrograms per kilogram taking over 40 minutes) with continuous vital sign monitoring, the dose can be altered according to response and the side effects, tolerability.Pre- treatment with Ketamine
A full physical examination must be done, and the results made available to the Anesthetist. (CBC, FBC, U&Es, LFTs ECG), are indicated.
Day of Treatment with Ketamine
Administration of ketamin Infusion
Side effects of Ketamin Therapy
The side effects of using ketamine depend on factors such as the amount used, the method of intakes.
1. Psychiatric Side Effects of Ketamine Include
Anxiety, Agitation or irritation, Frustration or anger, Drowsiness, Confusion, Dizziness, Amnesia, Difficulties concentrating, Disorientation, Delusions, Hallucinations, Dissociation.
2. GIT Side Effects of Ketamine Include
Stomach Upset, Nausea, Vomiting.
3. Cardiovascular Side Effects of Ketamine Include
Decreased heart rate, Irregular heartbeat, Increased blood Pressure.
4. Respiratory Side Effects of Ketamine Include
Slowed breathing.
5. Ophthalmologic Side Effects of Ketamine Include
Involuntary eye movements, Double vision.
6. Neurologic Side Effects of Ketamine Include
Decreased motor function, Seizures.
Figure 3: Ketamine Therapy for Depression Fact & Figures.
Termination of Treatment with Ketamin Therapy
Will be done if there is no response to the number of agreed sessions or if there a consistent nonresponse for 3 consecutive sessions or patient noncompliance by Ketamine treatment protocol.
Off-Label Usages of Ketamine in Psychiatric Field
Mood disorders, Post-Traumatic Stress Disorder (PTSD), Bipolar Disorder, Obsessive- Compulsive Disorder (OCD), Substance abuse management.
This psychiatric disorder not approved till now but research papers concluded a positive impact with Ketamine treatment.
Conclusion
Ketamine treatment for Resistant Depression Disorder includes pharmacotherapy, psychotherapy Currently oral antidepressants are the mainstay form of pharmacotherapy there is an overwhelming need to address the obstacles in treating Resistant Depression Disorder due to the delayed treatment response with oral antidepressants and the poor response rate new modalities and drugs can be explored to alleviate the severity of symptoms while ketamine was initially approved as a general anesthetic, it has been repurposed to treat Resistant Depression Disorder, suicidal ideation, and other off-label uses such as substance-use disorders and Mood Disorders, PTSD, Bipolar Disorder, OCD. Following FDA approval of intranasal (S)-ketamine used in conjunction with an oral antidepressant, other potential routes of administration, including intravenous is currently being researched and explored. An advantage of IV administration is the rapid antidepressant response observed the effects of ketamine in these patients can be observed within 24 hours of the initial dose and last 4-7 days after one intravenous infusion. Ketamine therapy response rates in controlled trials have ranged from 25% to 85% at 24 hours post infusion and from 14% to 70% at 72 hours post infusion.
Disadvantage of IV ketamine administration Was its side effects, the high cost, special precautions and Commitment of the protocol and guidelines of Ketamine therapy. Ketamine been associated with the potential for abuse due to its ability to cause psychotropic side effects. The costs and benefits must be considered before treatment with ketamine begins.
Conflicts of Interest
The authors declare that there is no conflict of interest regarding the publication of this article.
Funding& Support
This research did not receive grants from any funding agency in the public and commercial sector.
References
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- Maged, H. (2025). Protocol and Guidelines for Ketamine use in Psychiatric Disorders. Available at SSRN 5395747.
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