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Is Off-label repeat prescription of ketamine as a rapid antidepressant safe? Controversies, ethical concerns, and legal implications

Overview of attention for article published in BMC Medical Ethics, January 2016
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About this Attention Score

  • In the top 25% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (93rd percentile)

Mentioned by

news
3 news outlets
twitter
2 tweeters
facebook
1 Facebook page
wikipedia
2 Wikipedia pages
reddit
1 Redditor

Citations

dimensions_citation
37 Dimensions

Readers on

mendeley
143 Mendeley
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Title
Is Off-label repeat prescription of ketamine as a rapid antidepressant safe? Controversies, ethical concerns, and legal implications
Published in
BMC Medical Ethics, January 2016
DOI 10.1186/s12910-016-0087-3
Pubmed ID
Authors

Melvyn W. Zhang, Keith M. Harris, Roger C. Ho

Abstract

Depressive disorders are a common form of psychiatric illness and cause significant disability. Regulation authorities, the medical profession and the public require high safety standards for antidepressants to protect vulnerable psychiatric patients. Ketamine is a dissociative anaesthetic and a derivative of a hallucinogen (phencyclidine). Its abuse is a major worldwide public health problem. Ketamine is a scheduled drug and its usage is restricted due to its abuse liability. Recent clinical trials have reported that ketamine use led to rapid antidepressant effects in patients suffering from treatment-resistant depression. However, various flaws in study designs, and possible biased reporting of results, may have influenced those findings. Further analyses of ketamine use are needed to ensure patient safety. The use of ketamine in research and treatment of depressive disorders is controversial. Recently, mental health professionals raised ethical concerns about an ongoing ketamine trial in the UK. Also, a Canadian agency reviewed the existing evidence and did not recommend prescribing ketamine to treat depressive disorders. Findings obtained from tightly controlled research settings cannot be easily translated to clinical practice as substance abuse is commonly comorbid with depressive disorders. An effective antidepressant should reduce severity of depressive symptoms without liability problems. Although the US FDA has not approved the use of ketamine to treat depressive disorders, some psychiatrists offer off-label repeat prescription of ketamine. Prescribing ketamine for treating depressive disorders requires substantial empirical evidence. Clinicians should also consider research findings on ketamine abuse. Depressive disorders can be chronic conditions and the current evidence does not rule out the risk of substance abuse after repeat prescription of ketamine. Off-label ketamine use in treating depressive disorders may breach ethical and moral standards, especially in countries seriously affected by ketamine abuse. This article presents two real-world clinical vignettes which highlight ethical principles and theories, including autonomy, nonmaleficience, fidelity and consequentialism, as related to off-label ketamine use. We urge clinicians to minimise the risk of harming patients by considering the empirical evidence on ketamine properties and attempting all standard antidepressant therapies before considering the off-label use of ketamine.

Twitter Demographics

The data shown below were collected from the profiles of 2 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 143 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
France 1 <1%
Australia 1 <1%
Unknown 141 99%

Demographic breakdown

Readers by professional status Count As %
Student > Bachelor 26 18%
Researcher 24 17%
Student > Master 15 10%
Other 13 9%
Student > Postgraduate 12 8%
Other 23 16%
Unknown 30 21%
Readers by discipline Count As %
Medicine and Dentistry 42 29%
Psychology 17 12%
Neuroscience 12 8%
Pharmacology, Toxicology and Pharmaceutical Science 11 8%
Biochemistry, Genetics and Molecular Biology 7 5%
Other 20 14%
Unknown 34 24%

Attention Score in Context

This research output has an Altmetric Attention Score of 25. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 15 September 2022.
All research outputs
#1,238,533
of 22,078,848 outputs
Outputs from BMC Medical Ethics
#102
of 960 outputs
Outputs of similar age
#24,061
of 376,794 outputs
Outputs of similar age from BMC Medical Ethics
#1
of 1 outputs
Altmetric has tracked 22,078,848 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 94th percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 960 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 14.6. This one has done well, scoring higher than 89% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 376,794 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 93% of its contemporaries.
We're also able to compare this research output to 1 others from the same source and published within six weeks on either side of this one. This one has scored higher than all of them