Consensus Guidelines for IV Ketamine: Safe Clinical Practice

Sandhya Prashad, MD, elaborated on the key clinical recommendations emerging from the American Society of Ketamine Physicians, Psychotherapists, and Practitioners (ASKP3) recently published interdisciplinary, Delphi-driven consensus guidelines for IV ketamine. The guidelines are organized across 7 domains: published evidence base, clinician qualifications, treatment settings, psychiatric evaluation, medical evaluation, safe initiation and maintenance, and informed consent and documentation.¹

Prashad highlighted several clinical takeaways. On dosing, the panel confirmed that the acute antidepressant effects of IV ketamine are well established, with a standard induction series of 4 to 6 infusions over 2 to 4 weeks, typically initiated at 0.5 mg/kg administered over 40 minutes. A clinically significant finding was the panel's conclusion that there is limited supporting evidence for doses above 1 mg/kg, despite considerable dosing variability observed in community practice. Prashad emphasized that exceeding this threshold requires individualized clinical justification grounded in the patient's demonstrated response rather than arbitrary dose escalation.

On setting and personnel, the panel reached strong consensus that treatment must occur in settings capable of cardiorespiratory monitoring and that trained, experienced staff are essential to safe delivery. Notably, the guidelines did not recommend restricting IV ketamine administration to anesthesiology or critical care specialists, instead emphasizing adequate medical and psychiatric competence and a team-based care model. The panel also stressed the importance of longitudinal outcome tracking to confirm that individual patients are achieving meaningful improvement in depressive symptoms.

Additional recommendations addressed sourcing—with FDA-approved manufacturers preferred when possible—and the broader clinical framework within which ketamine should be embedded. The panel was unambiguous that IV ketamine should never be delivered as an isolated infusion but must be situated within a comprehensive psychiatric evaluation, a robust informed consent process that explicitly communicates that ketamine is a treatment and not a cure, an ongoing treatment plan, psychological aftercare, and, where appropriate, psychotherapy.² Prashad noted that a complementary consensus document from a predominantly academic psychiatric group is expected to be published soon, and that the 2 documents together should provide clinicians with a comprehensive, mutually reinforcing framework.

Dr Prashad is a board-certified psychiatrist specializing in interventional psychiatry and president of the American Society of Ketamine Physicians, Psychotherapists, and Practitioners.

References

1. McInnes LA, Aslam AM, Prashad S, et al. Interdisciplinary, Delphi-driven consensus guidelines on the use of intravenous ketamine infusions for depressive disorders from the American Society of Ketamine Physicians, Psychotherapists, and Practitioners (ASKP3). J Affect Disord. 2026;411:121970.

2. McInnes LA, Qian JJ, Gargeya RS, et al. A retrospective analysis of ketamine intravenous therapy for depression in real-world care settings. J Affect Disord. 2022;301:486–495.