• Jolien K E Veraart, Sanne Y Smith-Apeldoorn, Hayley Trueman, Marrit K de Boer, Robert A Schoevers, and Rupert McShane.
• Department of Psychiatry, University Medical Center Groningen and Research School Behavioral and Cognitive Neurosciences, University of Groningen, the Netherlands.
• BJPsych Open. 2018 Sep 1; 4 (5): 389-392.

BackgroundOff-label ketamine treatment has shown acute antidepressant effects that offer hope for patients with therapy-resistant depression. However, its potential for integration into treatment algorithms is controversial, not least because the evidence base for maintenance treatment with repeated ketamine administration is currently weak. Ketamine is also a drug of misuse, which has raised concerns regarding the target population. Little is known about which patients would seek ketamine treatment if it were more widely available.AimsTo explore some of the characteristics of the patients actively seeking ketamine treatment.MethodAn online survey containing questions about duration of current depressive episode, number of antidepressants used and other comments was completed by patients who were exploring the internet regarding the possibility of ketamine for depression.ResultsOf the 1088 people who registered their interest, 93.3% reported depression, 64.3% reported a chronic course of their symptoms and in the past 10 years, 86.3% had tried at least two antidepressants. Desperation was a common theme, but this appeared to be competently expressed. A small minority (<8%) reported experience of illegal ketamine use.ConclusionsIt cannot be ruled out that patients with different degrees of treatment resistance and comorbidities will seek treatment with ketamine. This stresses the urgency to perform larger randomised controlled trials as well as to systematically monitor outcomes and adverse effects of ketamine, that is currently prescribed off-label for patients in need.Declaration Of InterestR.M. is consulting and is Principal Investigator for Janssen trials of esketamine and is consulting for Eleusis.

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