Developing an Evidence-Based Clinical Protocol for IV Ketamine Therapy

Background: Intravenous (IV) ketamine is rising as a novel pharmaceutical option manifesting rapid and robust symptom reduction and offering much promise in alleviating Treatment-Resistant Depression (TRD). Clear and consistent evidence-based practice protocols and guidelines are lacking as practitioners seek to offer IV ketamine treatment to their patients. Methods: A science translation project was developed at a general community mental health clinic led by Psychiatric Mental Health Nurse Practitioners (PMHNPs). An evidence-based IV ketamine protocol for the treatment of TRD was drafted utilizing a literature review. In addition, participant surveys, an associated educational module, and ongoing protocol reviews were done. The final protocol was refined and presented in an executive summary to key clinic stakeholders. Results: IV ketamine demonstrates rapid and robust efficacy in the treatment of TRD. Emerging standards of practice include IV ketamine administered at a dose of 0.5-1 mg/kg over 40 minutes at a frequency of 6-8 infusions over 2-3 weeks. The role of a licensed mental health provider, such as a PMHNP, is vital to successful and optimal IV ketamine therapy treatment outcomes. Conclusion: Emerging science concerning IV ketamine therapy for TRD must be translated into safe practice guidelines, guided by evidence-based standards to reduce the gap in effective treatments. Robust research is culminating in critical components of care related to evidence- based approaches for IV ketamine in the treatment of TRD, fostering a powerful framework for a universal standard of practice. Formulating a protocol and guidelines for care based on emerging evidence was a key component of providers' confidence in accepting the drafted protocol.