Can a Framework Be Established for the Safe Use of Ketamine?

Freedman et al cites that pharmaceutical industry scientists have begun studies to support approval for general clinical use of intranasal esketamine for treatment-resistant or acutely suicidal patients with major depression. Although suicidal ideation generally decreases transiently after interventions for attempted or imminent suicide, many patients will make another attempt within a year. Therefore, more effective therapies are needed. Ketamine drug-seeking behavior has already appeared as a clinical issue, with some patients shopping infusion clinics to obtain repeated injections for mood elevation.