Ketamine treatment for depression: opportunities for clinical innovation and ethical foresight

Lancet Psychiatry. 2017 May;4(5):419-426. doi: 10.1016/S2215-0366(17)30102-5. Epub 2017 Apr 5.


We present a review and analysis of the ethical considerations in off-label ketamine use for severe, treatment-resistant depression. The analysis of ethical considerations is contextualised in an overview of the evidence for ketamine use in depression, and a review of the drug's safety profile. We find that, based on current evidence, ketamine use for severe, treatment-resistant depression does not violate ethical principles; however, clinicians and professional bodies must take steps to ensure that guidelines for good practice are enacted, that all experimental and trial data are made available through national registries, and that the risk potential of ketamine treatment continues to be monitored and modelled. We conclude with a set of key recommendations for oversight bodies that would support safe, effective, and ethical use of ketamine in depression.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antidepressive Agents / adverse effects
  • Antidepressive Agents / therapeutic use*
  • Depression / drug therapy*
  • Depressive Disorder, Treatment-Resistant / drug therapy*
  • Humans
  • Ketamine / adverse effects
  • Ketamine / therapeutic use*
  • Off-Label Use / ethics*
  • Off-Label Use / legislation & jurisprudence
  • Patient Safety*
  • Practice Guidelines as Topic
  • Randomized Controlled Trials as Topic


  • Antidepressive Agents
  • Ketamine