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Intravenous ketamine has shown promise for refractory depression (NEJM JW Psychiatry Sep 26 2013). To avoid the inconvenience of this mode of administration, investigators with a proprietary interest in ketamine conducted a randomized, double-blind, crossover study of a single 50-mg intranasal dose of ketamine or saline in 18 patients (mean age, 48; duration of current episode, 15 years) who had failed to respond to an average of four adequate trials of antidepressants (4 patients had received electroconvulsive therapy). Patients continued their antidepressants, which were unnamed, and were crossed to the other arm at least 1 week later.
Ketamine reduced depression rating scale scores significantly more than placebo beginning within 40 minut…