Some clinics add oral drugs with known NDMA action between IV ketamine treatments for patients with depression. The goal being to prolong the effects of ketamine until the patient’s next appointment. It shouldn't surprise anyone that this off-label guessing game has little to do with evidence and more to do with keeping patients on a $500/month treatment plan. Throw something at the wall and maybe it will stick?
A recent study in Neuropsychopharmacology may give these doctors a new tool. The result of this human study contradicted the results of a previous rodent study by showing that the immunosuppressive drug Rapamycin can increase the remission rate of ketamine at two weeks post infusion. It looks promising but there are still a lot of unknowns to uncover.
The field of psychiatry has been interested in reducing the frequency and dosage of ketamine treatments based on the oft-quoted line that we just don't know enough yet. This is evident in the guidance for recently approved intranasal esketamine. Reducing the frequency of a therapy that seems to be working does seem unethical. I wonder how those conversations between patient and doctor will end?
Additional NMDA drug candidates in the pipeline have been presented as the future daily drivers of the depressed because they lack some of the transient side effects present in ketamine. Patients naturally dislike insomnia and sexual side effects common with the SSRI class of drugs. Do they dislike the side effects of ketamine even more? Do the researchers care?