Date of Award

2024

Document Type

Thesis

Degree Name

MS in Pharmacy Administration

Department

Pharmacy Administration and Public Health

First Advisor

Rajesh Na

Second Advisor

Somnath Pal

Third Advisor

Martha Mackey

Abstract

Background: Major Depressive Disorder (MDD) significantly impacts society, with a prevalence of 8.4% in the U.S., highlighting the need for effective treatments for treatment-resistant depression (TRD). Ketamine, while not FDA-approved for TRD, shows promise in treating mental health disorders and is used in specialized clinics, though evidence of effectiveness is scarce. Objectives: This study investigates the use of off-label ketamine for TRD and other disorders, focusing on ketamine clinic operations where the drug is administered, treatment methods, patient characteristics, and ketamine's impact on psychiatric care, from providers' perspectives. Methods: The survey was distributed to over 1,000 ketamine providers across the U.S, targeting members of professional organizations - ASKP3, Osmind and Big Tent Ketamine. This survey aimed to assess a wide range of aspects related to ketamine utilization in psychiatric care including: treatment processes, clinical protocols, patient care, and operational factors. Results: Of all the survey respondents (n=71), regarding practice specialty, the provider groups represented included Psychiatrists/Psychologists (30.88%) and Physicians/General Medical Doctors (44.12%). 96% of the providers reported high involvement in the ketamine treatment processes and participation in subsequent monitoring and patient safety protocols. Results revealed that 92.1% of respondents identified TRD as the leading indication for ketamine administration, The survey also indicated a strong preference for the use of IV Ketamine (72.06%) among clinics. Clinics reported treating a balanced mix of male and female patients, with a majority serving middle-aged adults (36-64 years old), constituting 84.2% of the patient population. Based on the provider estimates, most patients belonged to the middle class (38.5%), with a significant representation of the upper-middle class (27.1%). 1 in 4 patients paid for services through insurance coverage, with a substantial portion paying out of pocket. Conclusion: This survey highlights ketamine's effectiveness and emerging role in treating psychiatric disorders like TRD. It demonstrates ketamine therapy's potential in various clinical settings, although variability in practice and challenges in affordability and access necessitate standardized guidelines and policy changes to enhance insurance coverage. As the medical community explores ketamine's potential, this thesis provides a foundation for current practices and advocates for its future integration into mainstream psychiatric treatment.

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