Rankings / Mood, Anxiety & Stress
Ketamine
Mood, Anxiety & Stress · NMDA antagonist
Tier B-
Bottom line
Read Off Label grades Ketamine as B- (6.0/10) based on strong evidence, med-high benefit magnitude, and a med-high-risk safety profile.
Paradigm-shifting for TRD since Berman 2000 and Zarate 2006.
Typical use: 0. — Rx (Schedule III US); esketamine REMS program.
What this is
Paradigm-shifting for TRD since Berman 2000 and Zarate 2006. Telehealth ketamine programs exploded 2020-2024 with questionable oversight; bladder damage from chronic use well-documented. Recreational use and 'K-hole' highly dissociative. Matthew Perry death from ketamine overdose October 2023.
Mechanism
Non-competitive NMDA receptor antagonist; also mu-opioid, dopaminergic, cholinergic activity; rapid-onset antidepressant; S-enantiomer (esketamine/Spravato) FDA-approved for TRD 2019
Dose & route
0.5 mg/kg IV over 40 min (depression); 40-85 mg intranasal esketamine
Citations
- https://pubmed.ncbi.nlm.nih.gov/16894061/
- https://pubmed.ncbi.nlm.nih.gov/30715137/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC6513787/
- https://clinicaltrials.gov/study/NCT01538745
Links go to the source. If a link is dead or you want something re-checked, let me know.
Common questions
- Does Ketamine work?
- Read Off Label rates the evidence for Ketamine as Strong and the benefit magnitude as med-high, producing an overall grade of B- (6.0/10). Paradigm-shifting for TRD since Berman 2000 and Zarate 2006.
- Is Ketamine safe?
- Ketamine has a med-high risk profile in published human data. Legal status: Rx (Schedule III US); esketamine REMS program. This is not medical advice — see the disclaimer.
- What is the typical dose for Ketamine?
- 0.5 mg/kg IV over 40 min (depression); 40-85 mg intranasal esketamine
- How does Ketamine work?
- Non-competitive NMDA receptor antagonist; also mu-opioid, dopaminergic, cholinergic activity; rapid-onset antidepressant; S-enantiomer (esketamine/Spravato) FDA-approved for TRD 2019
This is an independent synthesis of published research by a non-clinician. Scores are opinions supported by citations, not prescriptions. See the full disclaimer and methodology for how this score was produced and what it does and doesn't mean.