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it is safe to administer even in an outdoor setting (Administered to US marines during Vietnam War)
Ketamine is very fast acting antidepressant and works within 24 hours as compared to a couple of weeks for conventional treatments.
Ketamine’s rapid onset of symptoms’ relief is particularly useful in treating suicidal tendencies.
Ketamine has a superior antidepressant effect in alcoholic patients.
Optimization involves dose increment to a tolerable level where symptoms start to subside, at least, partially. Ketamine is recommended in low dose of 0.5 mg/kg over 40 minutes for initial therapy and after two weeks, its dose can be increased up to 0.75 mg/kg. It can be given as a single dose and can be repeated several times as per need.
Augmentation involves adding a non-antidepressant drug with the main antidepressant drug. Here ketamine can be used in combination with a variety of drugs like asenapine (Atypical Antipsychotic, or Second Generation Antipsychotic Drug), Benzodiazepines, Modafinil, Lithium and Thyroid hormone (T3). Augmentation strategies are useful in cases of partial response.
Combination refers to when two or more antidepressant drugs are combined for treatment. Here Ketamine can be combined with traditional first line antidepressants like sertraline and escitalopram safely. Combination strategies can be used in both partial and treatment failure cases.
Switching refers to change of primary medication when it fails to provide relief. Ketamine, with novel mechanism of action offers particular promise to treatment resistant depression patients. The results between augmentation and switching are comparable but switching is relatively safe because patient has to take only one drug. Switching strategies are usually applied after initial treatment failure.