Efficacy of IV vs. Oral Ketamine for Chronic Pain and Depression

Ketamine for Depression

The American College of Physicians suggests that IV ketamine shows rapid and significant improvement in depressive symptoms for treatment-resistant depression, with effects appearing within 24 hours and lasting 3-7 days 2, 3, 4
The American Psychiatric Association recommends that when used as an adjunct to ongoing antidepressant treatment, IV ketamine's antidepressant effects can persist for up to 7 days, while ketamine monotherapy effects may diminish after 7 days 2, 5
The National Institute of Mental Health indicates that IV ketamine has also demonstrated efficacy in reducing suicidal ideation in patients with major depressive disorder and suicidal ideation 6, 7

The American Geriatrics Society states that IV ketamine has demonstrated efficacy for refractory cancer pain and neuropathic pain conditions, though results from studies have been conflicting 8, 1
The National Comprehensive Cancer Network recommends that as an NMDA receptor antagonist, ketamine can help limit central sensitization, hyperalgesia, and opioid tolerance, making it valuable for complex pain conditions 1
The American Society of Anesthesiologists suggests that IV administration allows for precise dosing and rapid onset of action, which is beneficial for breakthrough pain management 1, 9

The American Geriatrics Society advises that IV ketamine administration requires monitoring for adverse effects such as psychotomimetic experiences and hypertension 8
The American Society of Anesthesiologists recommends that when administering IV ketamine, a loading dose of no more than 1.5 mg/kg given over 10 minutes is recommended, followed by an infusion at 1.5 mg/kg/h 9
The American Psychiatric Association indicates that both routes of administration should be reserved for patients who have not responded to conventional treatments for depression or pain management 2, 7