Royal Australian and New Zealand College of Psychiatrists Professional Practice Guidelines for the Use of Ketamine in Psychiatric Practice: Section on Comparison With ECT

 

I am leaving this post up for the next few days, so that it gets as many views as possible.

Out on PubMed, from authors Down Under, is this paper:

Royal Australian and New Zealand College of Psychiatrists professional practice guidelines for the use of ketamine in psychiatric practice.

Hussain S, Gale C, Sarma S, Smith J, Bayes A, Loo C.Aust N Z J Psychiatry. 2025 Apr 28:48674251333577. doi: 10.1177/00048674251333577. Online ahead of print.PMID: 40290038

The abstract is copied below:

Professional practice guidelines for the use of ketamine in psychiatric practice have been developed by the Royal Australian and New Zealand College of Psychiatrists to provide guidance on the use of ketamine in clinical practice in Australia and Aotearoa New Zealand, based on scientific evidence and supplemented by expert clinical consensus. Articles and information were sourced from existing guidelines and published literature. The findings were then formulated into consensus-based recommendations and guidance by the authors. The guidelines were subjected to rigorous successive consultation within the Royal Australian and New Zealand College of Psychiatrists, involving the Section of Electroconvulsive Therapy and Neurostimulation Committee, its broader membership and expert committees. The guidelines are intended for psychiatrists and clinicians engaged in the use of ketamine therapy to facilitate best practice to optimise outcomes for patients. They strive to find the appropriate balance between promoting best evidence-based practice and acknowledging that evidence for ketamine use is continually evolving.

Keywords: Guidelines; depression; ketamine; professional practice; psychiatric disorders.

The paper is here.

The sections of interest are here:

Much of this guideline is reasonable and informational, but the conclusion of the "Comparison with ECT" is clinically tone deaf at best, medically irresponsible at worst.

To state twice (well, to be fair, they say "the data suggest") that ketamine is comparable to ECT continues the misinterpretation of several RCTs and meta-analyses. It also discounts clinical realities of urgently ill patients and the vastly different evidence bases for the two interventions.

I am also surprised that the "ECT and ketamine anaesthesia" section misses the opportunity to open with a sentence about how good ketamine is as an alternate induction agent in ECT.