Drug dependence and prescribing ketamine for treatment-resistant depression in Australia and New Zealand

Alistair Carroll; Adam Bayes; Mark Montebello; Jonathan Brett; Shalini Arunogiri; John B Saunders; Colleen K Loo

doi:10.1177/00048674241242315

Drug dependence and prescribing ketamine for treatment-resistant depression in Australia and New Zealand

Aust N Z J Psychiatry. 2024 Oct;58(10):831-838. doi: 10.1177/00048674241242315. Epub 2024 Apr 1.

Authors

Alistair Carroll^{1

2}, Adam Bayes^{1

2}, Mark Montebello^{3

4

5}, Jonathan Brett^{6

7

8

9}, Shalini Arunogiri^{10

11}, John B Saunders¹², Colleen K Loo^{1

2

13}

Affiliations

¹ Neuromodulation and Interventional Psychiatry, Black Dog Institute, Sydney, NSW, Australia.
² Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia.
³ Drug and Alcohol Services, Northern Sydney Local Health District, St Leonards, NSW, Australia.
⁴ Specialty of Addiction Medicine, The University of Sydney, Camperdown, NSW, Australia.
⁵ National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
⁶ Clinical Pharmacology & Toxicology and Addiction Medicine, St Vincent's Hospital, Sydney, NSW, Australia.
⁷ NSW Poisons Information Centre, The Children's Hospital at Westmead, NSW, Australia.
⁸ St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia.
⁹ Medicines and Health Intelligence, School of Population Health, University of New South Wales, Sydney, NSW, Australia.
¹⁰ Statewide Addiction and Mental Health Centre, Turning Point, Eastern Health, Melbourne, VIC, Australia.
¹¹ Monash Addiction Research Centre, Monash University, Melbourne, VIC, Australia.
¹² National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, QLD, Australia.
¹³ Cardiovascular program. The George Institute for Global Health, Sydney, NSW, Australia.

PMID: 38561896
DOI: 10.1177/00048674241242315

Abstract

Ketamine is a restricted and regulated medication in Australia and New Zealand, which has implications when considering treatment for patients with treatment-resistant depression and a history of illicit drug use, abuse or dependence. Regulations governing prescription of ketamine for treatment-resistant depression vary between jurisdictions in Australia and New Zealand, though most restrict use in those with drug dependence. There is substantial variation in definitions of drug dependence used in each jurisdiction, and between the legal and clinical definitions, with the latter specified in the current International Classification of Diseases, Eleventh Revision and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. This paper reviews the literature assessing the risk of ketamine misuse and dependence in patients with a history of illicit drug use, abuse or dependence and presents recommendations for psychiatrists who prescribe ketamine in such patients with treatment-resistant depression.

Keywords: Ketamine; depression; drug dependence; regulations.

Publication types

Review

MeSH terms

Antidepressive Agents / therapeutic use
Australia
Depressive Disorder, Treatment-Resistant* / drug therapy
Humans
Ketamine* / therapeutic use
New Zealand
Substance-Related Disorders* / epidemiology

Substances

Ketamine
Antidepressive Agents