57 providers of ketamine treatment answered the survey.
74% were in private practice, only 14% in academic settings, and the rest in other settings.
67% of these clinicians were psychiatrists, 23% were anesthesiologists, and the rest were from other specialties.
74% of respondents reported that they administered ketamine in an office-based setting.
Most of the respondents had started providing ketamine treatment for psychiatric disorders only recently. The authors note that since 2012 there has been a substantial increase in the number of clinicians providing ketamine treatment.
For what diagnoses was ketamine being given? The three most common diagnoses were:
72% Major depressive disorder
15% Bipolar disorder
6% Posttraumatic stress disorder
And, it was not only being given intravenously (88% of respondents), but also orally (23%), or intranasally (19%).
The typical dose of ketamine used in research is 0.5 mg/kg given intravenously over about 45 minutes. But only 44% of respondents of those giving ketamine reported used that dose. Others reported using wider dose ranges that that.
During ketamine treatment, heart rate and pulse oximetry should be monitored. Most clinicians reported doing so, though how frequently these were checked varied.
Longer-term treatment with ketamine raises concern because there is little evidence to support such use and because there is concern about potential abuse or dependence. But, in this survey, 90% of the respondents reported offering ongoing ketamine treatment, i.e., for more than one month.
When used for maintenance, how often is ketamine given? There is wide variation in this:
once every 2 weeks (12%), once every 3 weeks (21%), monthly (30%), or less than monthly (16%).
Who is paying for this? Out of pocket -- 64% of patients, a portion reimbursed by insurance -- 23%, and “Other” -- 13%.