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Background Ketamine has emerged as a promising pharmacotherapy for depression and other mental illnesses, and the intramuscular (IM) administration of ketamine is now offered at many North American outpatient psychiatric clinics. However, a characterization of the outpatient population receiving IM ketamine treatment, and an evaluation of the real-world efficacy and safety of long-term IM ketamine treatment, has not been reported. This study aimed to evaluate the clinical characteristics, treatment patterns, clinical outcomes, and adverse events of patients receiving IM ketamine treatment.Methods Patient data from the electronic health records of a private outpatient psychiatric clinic network in the United States were collected and analyzed retrospectively. Adults who received ketamine treatment only by IM administration from January 2018 to June 2021 were included; a total of 452 patients were included in the cohort.Results Patients receiving IM ketamine treatment had a mean of 2.8 (SD 1.4) psychiatric diagnoses. 420 (93%) patients had a diagnosis of major depressive disorder, 243 (54%) patients had a diagnosis of generalized anxiety disorder, and 126 (28%) patients had a diagnosis of post-traumatic stress disorder. Thirty-seven percent (42/114) of patients reported a history of a previous suicide attempt, and patients had an average of 3.1 (SD 2.9) psychiatric medication prescriptions at baseline. Patients received between 1 and 48 IM ketamine treatments. Average depression and anxiety symptoms both significantly improved by 34% (p < .001) from baseline (PHQ-9: mean=16.3, SD=6.7; GAD-7: mean=12.8, SD=5.7) to patients’ last treatment (PHQ-9: mean=10.8, SD=5.9; GAD-7: mean=8.4, SD=5.5), and suicidal ideation scores also significantly improved (p < .001) . With maintenance ketamine treatments, median improvements in depression and anxiety of at least 21% and 19% were maintained for over 13 months. An adverse event occurred during 59 of 2,532 treatments (2.3%).Conclusions IM ketamine is being utilized to treat psychiatric outpatients with a moderate-to-severe mental health history and multiple mental illnesses not limited to depression. Average depression and anxiety levels significantly improve throughout IM ketamine treatment and do not regress to baseline for over one year with maintenance treatments. Prospective studies are recommended to confirm the long-term efficacy and safety of IM ketamine. |
