Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India.
J Clin Psychiatry. 2017 Jul;78(7):e852-e857. doi: 10.4088/JCP.17f11738.
Ketamine, administered in subanesthetic doses, is an effective off-label treatment for severe and even treatment-refractory depression; however, despite dozens of studies across nearly 2 decades of research, there is no definitive guidance on matters related to core practice issues.
This article presents a qualitative review and summary about what is known about ketamine dosing, rate of administration, route of administration, duration of treatment, and frequency of sessions.
Ketamine is most commonly administered in the dose of 0.5 mg/kg, but some patients may respond to doses as low as 0.1 mg/kg, and others may require up to 0.75 mg/kg. The ketamine dose is conventionally administered across 40 minutes; however, safety and efficacy have been demonstrated in sessions ranging between 2 and 100 minutes in duration. Bolus administration is safe and effective when the drug is administered intramuscularly or subcutaneously. Whereas the intravenous route is the most commonly employed, safety and efficacy have been described with other routes of administration, as well; these include oral, sublingual, transmucosal, intranasal, intramuscular, and subcutaneous routes. Patients may receive a single session of treatment or a course of treatment during the acute phase, and treatment may rarely be continued for weeks to years to extend and maintain treatment gains in refractory cases. When so extended, the ideal frequency is perhaps best individualized wherein ketamine is dosed a little before the effect of the previous session is expected to wear off.
There is likely to be a complex interaction between ketamine dose, session duration, route of administration, frequency of administration, and related practice. Until definitive studies comparing different doses, rates of administration, routes of administration, and other considerations are conducted, firm recommendations are not possible. From the point of view of clinical practicability, subcutaneous, intranasal, and oral ketamine warrant further study. If domiciliary treatment is considered, the risk of abuse must be kept in mind.
氯胺酮以亚麻醉剂量给药是一种有效的非标签治疗方法，用于治疗严重甚至治疗抵抗的抑郁症；然而，尽管近 20 年的研究进行了数十项研究，但对于核心实践问题相关的事项并没有明确的指导。
本文对氯胺酮的剂量、给药速度、给药途径、治疗持续时间和治疗频率等方面的知识进行了定性回顾和总结。
氯胺酮最常以 0.5mg/kg 的剂量给药，但有些患者可能对低至 0.1mg/kg 的剂量有反应，而有些患者可能需要高达 0.75mg/kg 的剂量。氯胺酮的剂量通常在 40 分钟内给药；然而，在 2 至 100 分钟的治疗期间，已经证明了安全性和疗效。当药物经肌肉或皮下给药时，推注给药是安全有效的。虽然静脉途径是最常用的途径，但其他途径的安全性和疗效也有描述，包括口服、舌下、黏膜下、鼻内、肌肉内和皮下途径。患者可能接受单次治疗或急性治疗期间的一个疗程治疗，并且在难治性病例中，治疗可能会罕见地延长数周至数年以延长和维持治疗效果。当如此延长时，理想的频率可能最好个体化，即氯胺酮在预计前一次治疗效果消退之前给药。
氯胺酮剂量、治疗持续时间、给药途径、给药频率以及相关实践之间可能存在复杂的相互作用。在进行比较不同剂量、给药速度、给药途径以及其他因素的研究之前，不可能提出明确的建议。从临床实践的角度来看，皮下、鼻内和口服氯胺酮值得进一步研究。如果考虑家庭治疗，必须牢记滥用的风险。
