Ketamine is an NMDA receptor antagonist that is FDA-approved as a general anesthetic. It also has shown benefit in a variety of mental health conditions, particularly when traditional treatments have failed. While FDA-approved ketamine is only available in an IV (intravenous) form, that product has been in-and-out of shortage.

Compounding pharmacies and outsourcing facilities are able to compound copies of these IV formulations during the period of shortage. Compounders can also create sublingual and nasal formulations that may be used in home-based treatment settings when prescribed and supervised by a qualified clinician. These forms offer flexible, patient-friendly administration that can be personalized and titrated based on patient needs, response, and tolerability.

All uses of ketamine for mental health, including depression, anxiety and PTSD, are considered off-label. However, a growing body of clinical experience supports ketamine's use in these treatment-resistant populations. 

• Use only under the direction and ongoing supervision of a qualified prescriber.
• Start with the lowest effective dose and adjust gradually based on response.
• Monitor for dissociative symptoms and consider counseling alongside treatment.
• Store securely and follow all safety and documentation protocols.
• Consider a slow dissolving sublingual version for ease of administration.