Mar 31, 2021
Welcome to PsychEd, the
psychiatry podcast for medical learners, by medical
This episode covers ketamine for
treatment-resistant depression (TRD) with Dr. Sandhya Prashad,
a psychiatrist and the
founder and medical director of Houston Ketamine Therapeutics. She
has extensive expertise using ketamine and is one of the most
experienced ketamine psychiatrists in the United States, with her
clinical practice focusing on TRD and incorporating transcranial
magnetic stimulation (TMS), sometimes in conjunction with ketamine.
Dr. Prashad is also a founding member and current president of the
American Society of Ketamine Physicians (ASKP), a non-profit
organization created to advocate for the safe use of ketamine for
mental illness and pain disorders and to expand access to ketamine
We’re also experimenting with
something new for this episode — providing a transcript of the
entire interview! The transcript can be found at psychedpodcast.org/transcripts/ketamine.
We’d love to hear your feedback as listeners on this as a feature,
including whether it’s something you’d be interested in seeing for
other episodes moving forward!
The learning objectives for this
episode are as follows:
By the end of this episode, you
should be able to…
- Describe ketamine and how it came to be used in
the field of psychiatry.
- Develop an appreciation for benefits and
potential harms associated with ketamine and how this compares to
other treatments for depression.
- Understand how ketamine fits into the treatment
of depression and suicidality, patient characteristics to consider
before initiation, potential mechanisms of action, different models
of administration, and incorporation of psychotherapy.
Guest expert: Dr. Sandhya
Hosts: Jimmy Qian (MS2), Dr.
Nikhita Singhal (PGY2), Dr. Chase Thompson (PGY3)
Audio editing by: Dr. Chase
Show notes by: Gray Meckling
Interview transcript by: Gray
00:00 – Introduction
03:00 – Learning
03:30 – History of
06:20 – Recreational use of
ketamine, phenomenology of the ketamine experience
09:45 – Where does ketamine fall
in the algorithm for treatment of depression?
11:50 – Ketamine’s use in acute
13:40 – Ketamine
14:40 – Ketamine
19:00 – Combining ketamine with
21:15 – Limitations to
24:35 – Ketamine mechanism of
26:05 – Ketamine formulations,
and integrating ketamine into psychotherapy
33:10 – Combining ketamine with
traditional antidepressant treatment
37:30 – Practicalities of
39:40 – Ketamine as treatment
for OCD and PTSD
41:40 – Closing
- Berman, R., Cappiello, A., Anand, A., Oren, D.,
Heninger, G., Charney, D.. (2000) Antidepressant effects of
ketamine in depressed patients. Biol Psychiatry 47:
- Daly, E. J., Trivedi, M. H., Janik, A., Li, H.,
Zhang, Y., Li, X., ... & Thase, M. E. (2019). Efficacy of
esketamine nasal spray plus oral antidepressant treatment for
relapse prevention in patients with treatment-resistant depression:
a randomized clinical trial. JAMA psychiatry, 76(9), 893-903.
- J.W. Murrough, D.V. Iosifescu, L.C. Chang, et
al. Antidepressant efficacy of ketamine in treatment-resistant
major depression: a two site randomized controlled trial. Am. J.
Psychiatry, 2013 (170) (2013), pp. 1134-1142
- Kim, J., Farchione, T., Potter, A., Chen, Q.,
& Temple, R. (2019). Esketamine for treatment-resistant
depression-first FDA-approved antidepressant in a new
class. N Engl J
Med, 381(1), 1-4.
- McIntyre, R. S., Rosenblat, J. D., Nemeroff, C.
B., Sanacora, G., Murrough, J. W., Berk, M., ... & Stahl, S.
(2021). Synthesizing the Evidence for Ketamine and Esketamine in
Treatment-Resistant Depression: An International Expert Opinion on
the Available Evidence and Implementation. American Journal of
- Muetzelfeldt L, Kamboj SK, Rees H, Taylor J,
Morgan CJA, Curran HV. Journey through the K-hole: Phenomenological
aspects of ketamine use. Drug and Alcohol Dependence [Internet].
2008 Jun 1;95(3):219–29.
- Sanacora G, Frye MA, McDonald W, Mathew SJ,
Turner MS, Schatzberg AF, Summergrad P, Nemeroff CB. A consensus
statement on the use of ketamine in the treatment of mood
disorders. JAMA psychiatry. 2017 Apr 1;74(4):399-405.
- Williams NR, Heifets BD, Blasey C, Sudheimer K,
Pannu J, Pankow H, Hawkins J, Birnbaum J, Lyons DM, Rodriguez CI,
Schatzberg AF. Attenuation of antidepressant effects of ketamine by
opioid receptor antagonism. American Journal of Psychiatry. 2018
- Williams NR, Heifets BD, Bentzley BS, Blasey C,
Sudheimer KD, Hawkins J, Lyons DM, Schatzberg AF. Attenuation of
antidepressant and anti suicidal effects of ketamine by opioid
receptor antagonism. Molecular psychiatry. 2019
- Zarate, C., Singh, J., Carlson, P., Brutsche,
N., Ameli, R., Luckenbaugh, D.. (2006a) A randomized trial of an
N-methyl-D-aspartate antagonist in treatment-resistant major
depression. Arch Gen Psychiatry 63: 856–864.
CPA Note: The views expressed in
this podcast do not necessarily reflect those of the Canadian
Psychiatric Association (CPA).
For more PsychEd, follow us on Twitter
(@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at
firstname.lastname@example.org. For more information, visit our website