Best practice advice for psychiatrists using short-term oral, under-the-skin, and nasal ketamine treatments for depression

Intranasal esketamine is regulated specifically for treatment-resistant depressive disorders in several jurisdictions.

• Ketamine and esketamine may offer rapid symptom reduction for treatment-resistant depression.
• Intranasal esketamine has established regulatory frameworks, while most ketamine formulations are used off-label.
• Practical recommendations are provided for using various ketamine formulations, including oral, subcutaneous, and nasal options.

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