Psychiatr. praxi. 2026;27(1):25-32 | DOI: 10.36290/psy.2026.004

Ketamine in clinical psychiatry and addictology - a narrative review

MUDr. Ondřej Vašíček^{1, 2}, MUDr. Tomáš Páleníček,Ph.D.^{1, 2, 3}

¹ Národní ústav duševního zdraví, Klecany

² 3. lékařská fakulta Univerzity Karlovy, Praha

³ Psyon - Psychedelická klinika, s. r. o, Praha

Ketamine administered at subanesthetic doses represents a rapidly acting and safe intervention with the most robust evidence for efficacy in major depressive disorder, particularly in treatment-resistant depression. In a subset of patients, a rapid reduction in suicidal ideation has also been observed. The effect of a single administration is typically time-limited and usually necessitates repeated or maintenance dosing within a defined clinical regimen. In clinical practice, off-label use of racemic ketamine is encountered alongside intranasal S-ketamine (Spravato®) used within officially approved indications, whereas R-ketamine remains experimental. The most common routes of administration are intravenous and intranasal, with alternative routes including intramuscular, subcutaneous, and oral administration, and investigated extended-release formulations. Outside depressive disorders, available data are heterogeneous and often limited; the greatest attention has been directed toward the potential use in post-traumatic stress disorder and obsessive-compulsive disorder. However, results are mixed, and standardized protocols for routine clinical implementation are lacking. In the field of addictology, ketamine is being investigated as an adjunct to psychotherapy in certain substance use disorders, with potential effects on craving and relapse, although the current evidence remains limited and indications require caution. With appropriate patient selection and adequate monitoring, ketamine demonstrates a favorable safety profile, characterized by transient dissociative/psychotomimetic and sympathomimetic effects. With repeated administration, monitoring of blood pressure, urinary tract symptoms, and liver function tests is recommended, along with systematic assessment of abuse potential and drug-drug interactions.

Keywords: ketamine, depression, psychiatric disorders, addictology, ketamine-assisted psychotherapy.

Accepted: March 12, 2026; Published: March 23, 2026  Show citation