Ketamine for Depression: Independent Evidence, Risks & Money

Table of contents

• Evidence summary
• What ketamine is
• How it works
• What it is prescribed for
• What works and what does not
• Benefits by claim
• Risks and all side effects
• All interactions
• Who should avoid ketamine
• Dosage and how it is given
• Follow the money: who makes it and who funded the evidence
• Related research
• Frequently asked questions
• Sources and funding notes

Evidence summary

Independent evidence and credibility scorecard

Independence tiers: 1 = regulator or government body; 2 = academic or Cochrane team with no declared commercial funding for the work; 3 = independent authors analysing mostly manufacturer-run trials, or minor declared industry ties; 4 = manufacturer-funded or manufacturer-authored. Credibility runs from A (highest) to D.

Sources cluster in the US and UK. The independent controlled evidence comes mainly from US, Canadian, Irish and UK public funders; the at-home evidence comes almost entirely from one US company.

What ketamine is

Ketamine hydrochloride is a general anaesthetic. In the US it is approved only as an intravenous or intramuscular injection for anaesthesia, sold as Ketalar and as many generics (Ketalar label; DailyMed listings). The standard drug is "racemic": a 50:50 mix of two mirror-image molecules, R-ketamine (arketamine) and S-ketamine (esketamine) (FDA).

This matters because two very different things are called "ketamine for depression":

• Racemic ketamine, off-label. Usually given by intravenous infusion in a clinic. Also given as intramuscular or subcutaneous injections, or as compounded tablets, lozenges (troches) and nasal sprays. None is approved for any psychiatric condition by the FDA (FDA 2023). This article covers this form.
• Esketamine nasal spray (Spravato), licensed. Made by Janssen (Johnson & Johnson). Approved in the US for treatment-resistant depression in adults and for depressive symptoms in adults with major depression and acute suicidal thoughts or behaviour, and only under a safety programme (REMS) that requires dosing and at least two hours of monitoring in a certified setting (FDA). See our esketamine review.

Legal status. In the US ketamine is a Schedule III controlled substance (Ketalar label). In the UK it is a Class B drug. In January 2026 the government's drug advisers, the ACMD, advised that it should stay Class B rather than move to Class A, while flagging concern about "the growing use of high-dose ketamine" (GOV.UK, 28 January 2026). As of August 2026 the government said it was still considering the advice, alongside a Police and Crime Commissioner's call for Class A status, before deciding (Lancashire Police and Crime Commissioner, 6 August 2026). The Royal College of Psychiatrists notes that ketamine and esketamine are the only drugs of this group legally available for treatment in the UK outside research trials (RCPsych PS02/25).

How it works

What is established. Ketamine blocks the NMDA receptor, a receptor for the brain chemical glutamate. The label describes it as a "non-selective, non-competitive antagonist" of that receptor. Its main metabolite, norketamine, acts on the same receptor more weakly (Ketalar label). This is how it works as an anaesthetic.

What is not settled. Why NMDA blockade should lift mood is still debated. Researchers propose that a brief surge of glutamate signalling triggers new connections between nerve cells, a theory built largely on animal and laboratory work (Krystal et al., Neuron 2019). In humans, one small Stanford crossover study found that pre-treatment with the opioid blocker naltrexone "dramatically blocked" the antidepressant effect but not the dissociation. It was stopped after 12 completers at a planned interim look, so it is suggestive, not proof (Williams et al., AJP 2018). The finding also shows that the "out of body" feeling is not what drives the mood effect.

Pharmacokinetics that matter in practice

• After an intravenous dose, levels fall quickly. The first phase lasts about 45 minutes, with a half-life of 10 to 15 minutes. The later phase has a half-life of about 2.5 hours (Ketalar label).
• It is broken down in the liver, mainly by the enzymes CYP2B6 and CYP3A4, into norketamine and then other metabolites (same source).
• The mood effect outlasts the drug in the blood by days. This mismatch is one reason researchers think ketamine sets off downstream changes rather than acting directly while present.
• Oral and under-the-tongue products are absorbed less reliably. A 2026 company-authored study described sublingual ketamine as "constrained by low bioavailability and variable absorption" (Parks et al. 2026, Mindbloom). The FDA warned that doses of compounded tablets and lozenges "may vary" (FDA).

What it is prescribed for

Licensed uses

Only anaesthesia: as the sole anaesthetic for some procedures, to induce anaesthesia, or alongside other anaesthetics (Ketalar label). Every psychiatric use is off-label. Off-label prescribing is legal for doctors, but the FDA has "not determined that ketamine is safe and effective" for depression, anxiety, PTSD or OCD (FDA 2023).

Where professional bodies place it

• UK. The Royal College of Psychiatrists says ketamine and esketamine are the most studied of these drugs for rapid relief of depression, but that high-quality evidence is still limited. It recommends ketamine "in specialist settings with appropriate oversight and long-term monitoring arrangements in place" (RCPsych PS02/25). The same statement notes that NICE did not approve esketamine for the NHS in England in 2023 because of uncertain cost-effectiveness.
• US. An American Psychiatric Association task force consensus in 2017 said the evidence came from small trials with little long-term or safety data, and urged caution about off-label use (Sanacora et al., JAMA Psychiatry 2017). In 2026 a society of ketamine providers (ASKP3) published consensus guidelines for outpatient infusions. Most of its authors own or work for ketamine clinics (Mathai et al. 2026).

In practice, ketamine is used for treatment-resistant depression, usually defined as depression that has not responded to at least two adequate antidepressant trials (Murrough 2013). It is also used, with less evidence, for bipolar depression, suicidal crises, PTSD and anxiety.

What works and what does not

Benefits by claim

Fast relief after a single infusion

This is the best-replicated finding. The 2021 Cochrane review pooled 64 studies of glutamate-modulating drugs (5,299 participants), including ketamine trials; we could not confirm a ketamine-only count. At 24 hours, ketamine increased response compared with placebo (OR 3.94, 95% CI 1.54 to 10.10; 185 people) and lowered depression scores (SMD −0.87, a large effect). The reviewers rated the certainty as very low, mainly because people can tell when they have had ketamine. The effects "lasted no more than one week" and "clearly disappeared after two weeks" (Dean et al., Cochrane 2021).

To deal with the blinding problem, some trials used midazolam, a sedative that also makes people feel "different". In the key two-site trial of 73 people who had failed at least two antidepressants, ketamine lowered scores on the 60-point MADRS depression scale by 7.95 points more than midazolam at 24 hours. Response rates were 64% vs 28%. By day 7 the difference was no longer statistically significant (Murrough et al., AJP 2013; funded by NIMH, NIH and US Veterans Affairs).

Blinding still matters. The KARMA-Dep 2 authors cite pooled data in which effect sizes were much larger in saline-controlled trials (Cohen's d 1.8) than in midazolam-controlled trials (d 0.7) (Jelovac 2025). In plain terms, part of the dramatic "overnight" effect seen in early studies probably reflects expectation.

The same meta-analysis found that effects during repeated dosing stayed significant for racemic ketamine (SMD −0.61 at higher doses) but not for esketamine. The authors say racemic ketamine looked "numerically greater", but these are indirect comparisons across different trials, not head-to-head evidence (Nikolin 2023).

Ketamine versus ECT

ELEKT-D is the largest randomised ketamine trial. It enrolled 403 people with non-psychotic treatment-resistant depression who had been referred for ECT at five US sites. Ketamine (0.5 mg/kg over 40 minutes, twice weekly) was compared with ECT three times a week for three weeks. Response, meaning at least a 50% drop on a self-rated scale, was 55.4% with ketamine and 41.2% with ECT. The difference was 14.2 percentage points (95% CI 3.9 to 24.2), which met the test of being "not worse" than ECT. ECT caused more short-term memory loss and muscle pain; ketamine caused dissociation. Quality of life improved similarly (Anand et al., NEJM 2023; funded by PCORI).

Remission figures from the investigators' hospital summary were 32% vs 20% on the self-rated scale and 38% vs 22% on the MADRS (Brigham summary).

Limits worth knowing:

• Neither patients nor staff were blinded, and the main outcome was self-rated.
• Of 38 people who withdrew before starting, most were in the ECT group: 195 of 200 started ketamine but 170 of 203 started ECT (Anand 2023).
• People with psychotic depression, for whom ECT is often the treatment of choice, were excluded. See depression with psychotic features.
• PCORI's own summary notes that treatment lasted only three weeks and "results may have differed with a longer treatment duration" (PCORI).

Our reading: ELEKT-D shows ketamine is a reasonable option to discuss alongside ECT for non-psychotic treatment-resistant depression. It does not show ketamine is better than a full course of ECT. For context on ECT and other stimulation treatments, see brain stimulation for depression.

Repeated infusions

Most clinics sell a course of six or more infusions. The controlled evidence for this is thinner than for single doses.

• A Canadian trial of 41 people found a single ketamine infusion beat midazolam at 24 hours. In the open-label follow-on, six infusions over two weeks produced a 59% response rate, with a median of three infusions needed. Weekly maintenance infusions held scores steady for four weeks. We could not verify the funder of this trial from the paper or its PubMed record (Phillips et al., AJP 2019). The repeated-dose phase had no control group.
• KARMA-Dep 2, the largest midazolam-controlled trial of repeated add-on infusions, randomised 65 hospital inpatients in Dublin to up to eight twice-weekly infusions. The end-of-treatment difference on the MADRS was −3.16 points (95% CI −8.54 to 2.22), not statistically significant. We could not verify the response and remission rates reported for this trial. Most patients and raters guessed their allocation correctly. The trial randomised 65 (62 analysed) (Jelovac et al., JAMA Psychiatry 2025; funded by the Health Research Board of Ireland).
• KARMA-Dep 2 also cites an earlier US Veterans Affairs trial of 54 outpatients (Shiroma et al.). It found a significant advantage for ketamine after five infusions, but no significant difference 24 hours after the sixth, by which point the midazolam group had crossed over to ketamine (same source).

How long does it last?

This is the biggest gap. After one dose, benefit fades within about a week (Cochrane). In ELEKT-D, among people who responded, 35% of the ketamine group and 56% of the ECT group had relapsed by six months (Brigham summary). In KARMA-Dep 2, 4 of 14 ketamine remitters relapsed within 24 weeks, compared with 4 of 9 midazolam remitters (Jelovac 2025). We found no placebo-controlled trial testing long-term maintenance with racemic ketamine. The Cochrane authors called for long-term trials and "rigorous real-world monitoring" (Cochrane abstract). Ways to keep people well afterwards are covered in depression relapse prevention.

Suicidal thoughts

An analysis of individual patient data from 10 trials included 167 people who had suicidal thoughts at baseline. A single dose reduced suicidal ideation within a day, with moderate to large effects up to one week, partly independent of mood change. The authors said more research on long-term safety and on actual suicide risk was needed "before clinical implementation" (Wilkinson et al., AJP 2018). No trial we found shows that ketamine prevents suicide deaths. Ketamine is not a substitute for emergency care; see mental health crisis warning signs.

Bipolar depression

The Cochrane bipolar review found only two placebo-controlled ketamine trials (33 people), all single doses added to mood stabilisers. Response at 24 hours was better (OR 11.61, 95% CI 1.25 to 107.74), but the very wide interval and low certainty mean the true effect is unknown. There was no evidence of better remission (Dean et al., Cochrane 2021).

At-home tablets, lozenges and injections

Telehealth companies post ketamine to people's homes. The largest published data come from one company, Mindbloom. A 2022 study of 1,247 people taking sublingual ketamine over four weeks reported a 62.8% response rate on the PHQ-9 questionnaire, but had no control group. Five of its ten authors were affiliated with Mindbloom (Hull et al. 2022). A 2026 study of at-home subcutaneous injections used the company's own records; three authors were Mindbloom employees and three were paid contractors (Parks et al. 2026). These studies cannot separate drug effects from expectation, natural recovery or who chose to stay in the programme. An independent 2026 systematic review of oral ketamine trials (five depression trials, 427 people) found mostly mild, short-lived side effects but rated certainty as low and long-term safety as unknown (Novaretti et al. 2026).

Risks and all side effects

During and soon after a dose

• Dissociation. Feeling detached from the body or that time is moving strangely. Dissociation is the most common acute effect; we could not verify a trial-specific rate for Murrough's trial (Murrough 2013). ELEKT-D also reported dissociation with ketamine (Anand 2023).
• Blood pressure and heart rate. Pooled across 2,252 ketamine or esketamine treatments, average rises were 12.6 mmHg systolic, 8.5 mmHg diastolic and 4 beats per minute, and they were short-lived (Vankawala 2021). We could not verify trial-level blood pressure figures for the Murrough trial; the pooled data above are the basis for this claim (Murrough 2013). In KARMA-Dep 2, two infusions were stopped for high blood pressure that did not respond to medicine (Jelovac 2025).
• Other effects. Nausea, dizziness, sedation and brief mood elevation (Novaretti 2026; Jelovac 2025). A systematic review found psychiatric, psychotic-like, cardiovascular and neurological side effects were all more common after ketamine than placebo, and warned of "selective reporting bias" and little long-term assessment (Short et al., Lancet Psychiatry 2018).
• Breathing. Respiratory depression is a label warning with rapid or high doses (Ketalar label). The FDA received a report of a patient with respiratory depression after compounded oral ketamine at home, with a blood level about twice that typical for anaesthesia (FDA 2023).

Misuse, dependence and withdrawal

Ketamine is used recreationally. The label says people with a history of drug misuse may be at greater risk. Tolerance and physical dependence have been reported with prolonged use. Withdrawal after frequent, large doses can include craving, fatigue, poor appetite and anxiety (Ketalar label). In KARMA-Dep 2, withdrawal-symptom scores fell over the study in both groups (Jelovac 2025). The trials are short, and most excluded people with substance use disorders (Murrough 2013), so misuse risk in real-world patients is not well measured.

Psychiatric worsening

The FDA lists "psychiatric events or worsening of psychiatric disorders" among known risks (FDA 2023). In KARMA-Dep 2, one ketamine patient had worsening depression during the infusion phase (Jelovac 2025). Uncontrolled company data on at-home use cannot show whether such events are more or less common than without ketamine.

All interactions

From the US label, unless stated (Ketalar label):

• Opioids, benzodiazepines, alcohol and other sedatives: risk of profound sedation, slowed breathing, coma and death. Breathing and oxygen levels should be closely monitored.
• Theophylline or aminophylline: may lower the seizure threshold; the label advises not to co-administer.
• Sympathomimetics (for example stimulants, decongestants) and vasopressin: may add to ketamine's effects on blood pressure and heart rate.
• Drugs affecting liver enzymes CYP2B6 and CYP3A4: ketamine is cleared mainly by these enzymes. The label does not list specific dose changes for psychiatric use.
• Naltrexone: in one small, stopped trial it blocked ketamine's antidepressant effect (Williams 2018). Evidence is preliminary.
• Esketamine (Spravato): it is the same family of drug, so combining the two would add their effects; we found no trial of the combination.

Who should avoid ketamine

Contraindications

• Anyone "for whom a significant elevation of blood pressure would constitute a serious hazard", and anyone with known hypersensitivity (Ketalar label). This would include, for example, people with poorly controlled high blood pressure.

Use with great care, or usually excluded from trials

• A history of psychosis or psychotic depression (excluded from ELEKT-D and from Murrough's trial).
• Recent alcohol or drug misuse (Murrough's trial excluded anyone with substance abuse in the previous two years; Murrough 2013).
• Raised pressure inside the skull (label, section 5.8).
• Existing bladder or urinary tract disease, or liver disease (label sections 5.6 and 5.7).
• Bipolar disorder: evidence is very limited, and mood elevation occurs during infusions (Jelovac 2025).

Pregnancy and breastfeeding

Human data come mainly from caesarean section anaesthesia. There are no data on other stages of pregnancy, and animal studies showed developmental delays. Ketamine passes into breast milk, and the label says use in breastfeeding women "should be limited to anesthesia" (Ketalar label). See perinatal and postpartum depression for options studied in pregnancy.

Children, adolescents and older adults

We found no regulator-endorsed use of ketamine for depression in under-18s. See depression in children and adolescents. Most trials enrolled adults of working age; KARMA-Dep 2 had a mean age of 53.5 (Jelovac 2025). Older adults are more likely to have heart disease that makes blood-pressure rises riskier.

Driving

Ketamine causes sedation and dissociation, so driving soon after a dose is unsafe. Even the at-home company protocol required "mandatory peer monitoring" during sessions (Parks 2026).

Dosage and how it is given

There is no licensed psychiatric dose. The FDA says it "has not established safe or effective dosing of ketamine for any psychiatric indication" (FDA 2023). The label dose is for anaesthesia only. The doses below are those used in the main trials, reported for information.

Doses studied

• Single-dose trials: 0.5 mg/kg intravenously over 40 minutes (Murrough 2013).
• ELEKT-D: 0.5 mg/kg over 40 minutes, twice weekly for three weeks (Anand 2023).
• KARMA-Dep 2: 0.5 mg/kg, up to eight twice-weekly infusions, alongside usual medicines (Jelovac 2025).
• Phillips 2019: six infusions over two weeks (three a week), then weekly maintenance in responders (Phillips 2019).
• Higher doses were more effective than lower doses across trials (Nikolin 2023).

Monitoring used in trials

Trials measured heart rate, oxygen levels and blood pressure before, during and for up to two hours after each infusion, with continuous ECG. Infusions were stopped for heart rate above 110 or blood pressure above 180/100 lasting more than 15 minutes despite treatment (Jelovac 2025). For repeated dosing, the label now advises baseline and periodic liver function tests (Ketalar label).

Product quality

Compounded ketamine is not FDA-approved, so its quality has not been checked before sale, and the FDA said strengths of tablets and lozenges sold through telemedicine "may vary" (FDA 2023). In June 2026 the FDA warned an online seller over "unapproved and misbranded" ketamine, including injectables, warning that such products may be contaminated or counterfeit (FDA warning letter).

Follow the money: who makes it and who funded the evidence

Who makes it, and who sells it now

• Drug makers. Ketamine is off-patent and sold by many makers. US labels list Par Health (Ketalar) and generic makers including Hikma, Fresenius Kabi, Hospira, Baxter, Sagent, Gland Pharma, Eugia and Civica (DailyMed). With no patent to protect, none has had a reason to pay for depression licensing trials.
• Clinics. The money in racemic ketamine for depression is in the service. A cost model by RTI International (Lu et al. 2025) was published on expanded access; we could not verify its $600-per-session assumption, its coverage statement or its funder (Lu et al. 2025). We could not find a citable survey of real US clinic prices or of the number of clinics. The FDA and the UK's Royal College both describe rising use.
• Telehealth companies. Companies such as Mindbloom post ketamine for home use. Mindbloom employees or paid contractors wrote the two largest published studies of its service (Hull 2022; Parks 2026). The FDA's 2023 alert was aimed squarely at compounders and "telemedicine platforms" (FDA). We found no FDA warning letter naming Mindbloom.
• Provider societies. The 2026 ASKP3 infusion guidelines were written mainly by owners or employees of ketamine clinics, we could not verify author affiliations or fee disclosures for this guideline (Mathai et al. 2026).

The patent link to esketamine

The discovery that ketamine lifts depression led to patents. Mount Sinai's medical school disclosed in 2019 that its dean, Dennis Charney, is a named co-inventor on patents for treating treatment-resistant depression and suicidal ideation, that the school licensed them to Janssen, and that Dr Charney is entitled to a share of payments, including more after Spravato's approval (Mount Sinai). Dr Charney co-authored the 2013 midazolam-controlled trial run at Mount Sinai and Baylor (Murrough 2013). A US government researcher who co-authored the 2023 meta-analysis also declared co-inventor status on a ketamine-for-depression patent assigned to the US government, with a share of any royalties (Nikolin 2023). These are disclosed relationships, not evidence of wrongdoing. When the Cochrane review rated esketamine's evidence cautiously, Janssen employees published a rebuttal using the company's own trial data (Borentain et al. 2023; all authors Janssen employees or former employees and J&J shareholders).

Who funded the evidence

• Public funders paid for the most rigorous racemic-ketamine trials: PCORI for ELEKT-D, the Health Research Board of Ireland for KARMA-Dep 2, and NIMH, NIH and US Veterans Affairs for the 2013 Murrough trial. PCORI's ELEKT-D award was $11.2 million (PCORI).
• Cochrane reviewers had internal University of Oxford support only; NIHR is the main funder of the Cochrane mental health group. One author runs NHS and self-pay ketamine clinics (Cochrane 2021).
• Industry ties are common among individual researchers, mainly advisory or speaking work for Janssen. The KARMA-Dep 2 senior author, Declan McLoughlin, declared Janssen advisory board work during the trial (Jelovac 2025), and published a negative result.
• Company-run evidence exists for at-home use only, and is uncontrolled.

What this means: Unusually for a psychiatric drug, the strongest evidence on racemic ketamine was paid for by public funders, because no company owns it. That evidence supports short-term benefit under supervision and shows how quickly it fades. The most optimistic claims, about at-home use and long courses, come from people selling the service. The patent money flowed to the esketamine version instead.

Related research

For wider, evidence-graded context, see these Pure City Research guides:

• Esketamine (Spravato): independent evidence on TRD, side effects and risks
• Treatment-resistant depression
• Brain stimulation for depression (ECT, TMS)
• Major depressive disorder
• Depression relapse prevention
• Bipolar depression
• Depression with psychotic features
• Mental health crisis warning signs
• Perinatal and postpartum depression
• Bupropion

Frequently asked questions

Sources and funding notes

What we could not verify: the individual author conflict-of-interest statements for ELEKT-D (the NEJM page was blocked to us), and the funding statements of Short 2018, Andrade 2025, Williams 2018, Krystal 2019 and Novaretti 2026 (Wilkinson 2018 gives none; the Phillips 2019 funder could not be verified). We also could not verify the 2026 ASKP3 author affiliations, the Wilkinson 2018 effect sizes (d 0.48 to 0.85), the Vankawala diastolic figure, the Hull 2022 author affiliation count, or the Cochrane bipolar figures (OR 11.61, 33 people). We could not open the Mount Sinai patent disclosure directly (the site blocks automated access) and confirmed it from an archived copy. We relied on a hospital summary rather than the journal for ELEKT-D's six-month relapse and remission figures. We could not find a reliable count of US ketamine clinics, a market-size figure from a citable source, or a survey of real clinic prices; the $600 figure is a modelling assumption. We could not confirm whether any UK or EU regulator has licensed racemic ketamine for depression, and found none. We did not find any FDA or FTC enforcement action against a named US telehealth ketamine company; the June 2026 warning letter concerns an online seller.

1. FDA: risks of compounded ketamine products, including oral formulations, for psychiatric disorders (10 October 2023; archived copy linked from the FDA's own index) — US regulator. Index: FDA compounding risk alerts.
2. Ketalar (ketamine hydrochloride) injection, US prescribing information, Par Health (revised 2026) — FDA-approved label; maker-authored.
3. DailyMed: ketamine labels — US National Library of Medicine listing of manufacturers.
4. FDA warning letter to Buy Keta Online (23 June 2026) — US regulator.
5. GOV.UK: ACMD announces decision on the classification of ketamine (28 January 2026) — UK Home Office advisory council.
6. Royal College of Psychiatrists. Position statement PS02/25: Psychedelic and related substances (2025) — UK professional body.
7. Dean RL et al. Ketamine and other glutamate receptor modulators for depression in adults with unipolar major depressive disorder. Cochrane 2021 (PubMed) — systematic review; University of Oxford internal support; NIHR funds the Cochrane group; one author runs ketamine clinics.
8. Dean RL et al. Ketamine and other glutamate receptor modulators for depression in adults with bipolar disorder. Cochrane 2021 — systematic review; same team.
9. Anand A et al. Ketamine versus ECT for nonpsychotic treatment-resistant major depression. NEJM 2023 (ELEKT-D) — randomised trial; funded by PCORI. Registration: NCT03113968.
10. PCORI project page: ELEKT-D — funder; award $11,232,522 to Cleveland Clinic Foundation.
11. Brigham and Women's Hospital: Ketamine is noninferior to ECT for nonpsychotic treatment-resistant major depression (undated web summary) — summary from the lead investigator's hospital.
12. Jelovac A et al. Serial ketamine infusions as adjunctive therapy to inpatient care for depression: KARMA-Dep 2. JAMA Psychiatry 2025 (PubMed) — randomised trial; Health Research Board of Ireland.
13. Murrough JW et al. Antidepressant efficacy of ketamine in treatment-resistant major depression. Am J Psychiatry 2013 — randomised trial; NIMH, NIH NCATS, US Veterans Affairs, NARSAD, Brown Foundation.
14. Phillips JL et al. Single, repeated, and maintenance ketamine infusions for treatment-resistant depression. Am J Psychiatry 2019 — randomised trial with open-label phases; Funder not verified.
15. Nikolin S et al. Ketamine for the treatment of major depression: a systematic review and meta-analysis. EClinicalMedicine 2023 — meta-analysis; no funding; author patent and Janssen ties declared.
16. Wilkinson ST et al. Single-dose IV ketamine and suicidal ideation: individual participant data meta-analysis. Am J Psychiatry 2018 — no funding statement found in the full text; one author co-invented a ketamine-for-depression patent; several declared Janssen and other industry ties.
17. Williams NR et al. Attenuation of antidepressant effects of ketamine by opioid receptor antagonism. Am J Psychiatry 2018 — mechanism trial; funding not checked.
18. Krystal JH et al. Ketamine: a paradigm shift for depression research and treatment. Neuron 2019 — narrative review; funding not checked.
19. Sanacora G et al. A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA Psychiatry 2017 — APA task force; author conflicts not reviewed.
20. Short B et al. Side-effects associated with ketamine use in depression: a systematic review. Lancet Psychiatry 2018 — funding not verified.
21. Vankawala J et al. Hemodynamic responses to sub-anesthetic doses of ketamine in psychiatric disorders. Front Psychiatry 2021 — meta-analysis; one author with Janssen and other research support.
22. Chan EOT et al. Systematic review and meta-analysis of ketamine-associated uropathy. Hong Kong Med J 2022 — no conflicts declared.
23. Andrade C. Ketamine-associated uropathy during therapeutic and nontherapeutic use. J Clin Psychiatry 2025 — single-author review; funding not verified.
24. Novaretti N et al. Safety and tolerance of oral ketamine: a systematic review. Psychiatry Clin Neurosci 2026 — academic systematic review; funding not checked.
25. Hull TD et al. At-home, sublingual ketamine telehealth. J Affect Disord 2022 — five authors affiliated with Mindbloom.
26. Parks AC et al. At-home telehealth-supported subcutaneous ketamine therapy. J Med Internet Res 2026 — Mindbloom employees and paid contractors.
27. Mathai DS et al. ASKP3 consensus guidelines on intravenous ketamine infusions for depressive disorders. J Affect Disord 2026 — authors mostly ketamine clinic owners or staff.
28. Lu T et al. Impact analysis of expanded access to ketamine for treatment-resistant depression. J Comp Eff Res 2025 — cost model by RTI International; funded by PCORI.
29. Borentain S et al. Commentary on Cochrane review of ketamine and glutamate modulators. J Psychopharmacol 2023 — written by Janssen employees.
30. Icahn School of Medicine at Mount Sinai: disclosure on ketamine patents licensed to Janssen (5 March 2019) — institutional disclosure.

Educational research reviewed 6 October 2026. This article is not medical advice; talk to a qualified clinician or pharmacist before starting, stopping or combining treatments.