Ketamine for comorbid treatment-resistant depression and substance use disorders: balancing risks and opportunities

Recent retrospective analyses have shown that individuals with comorbid Substance Use Disorders (SUDs) are overrepresented among responders to ketamine for Treatment Resistant Depression (TRD). Ketamine is an effective treatment for depression and also a potential substance of misuse. The authors contrast a mechanistic pathway with a possible expectancy effect to account for these findings, and urge careful consideration of risks and benefits when considering ketamine for individuals with TRD and SUDs.