Hospitals and clinics across the country are increasingly offering ketamine therapy to patients with severe depression, post-traumatic stress disorder, and other mental health conditions that have not responded to other treatments. While ketamine is generally considered safe when used under medical supervision, there is a little-known complication associated with its use – it can be harmful to a developing fetus. As a result, it should not be used during pregnancy. A recent study conducted by researchers from the University of Michigan’s academic medical center, Michigan Medicine, found that many ketamine prescribers do not pay enough attention to this risk and should do more to ensure that patients are not pregnant and are aware of the need to use contraception while undergoing treatment over several months.
The study, published in the Journal of Clinical Psychiatry, surveyed 119 clinics nationwide that offer ketamine treatment, revealing a wide variation in policies, practices, and warnings related to ketamine use and pregnancy. While over 75% of clinics reported having a formal pregnancy screening process, only 20% required a pregnancy test prior to or during treatment. More than 90% of clinics noted that pregnancy is a contraindication to ketamine treatment in their informed consent documents, but less than half discussed specific risks with patients. Additionally, only 26% of clinics discussed the potential need for contraception with patients, and less than 15% recommended or required contraception during treatment, despite the fact that many patients receive ketamine for extended periods.
The study’s lead author, Rachel Pacilio, M.D., highlighted the lack of standardization in reproductive counseling, pregnancy testing, and contraception recommendation among ketamine clinics. While clinics that offer intravenous ketamine have specialized staff and monitoring requirements, those providing other formulations of ketamine may have minimal oversight. The study did not include online ketamine providers that offer treatment exclusively via telehealth consultations, raising concerns about how these providers address reproductive and safety concerns.
Patients who become pregnant during ketamine treatment may face an increased risk of depression relapse if they have to stop taking the medication, which can have long-term consequences for both the parent and the infant. Additional interventions, such as improved patient education, routine pregnancy testing, and contraceptive counseling, are needed to ensure the safe use of ketamine in reproductive-age women. Standard guidance on pregnancy prevention and contraception use during ketamine treatment could benefit both large academic medical centers and small community clinics offering this therapy.
In response to the study’s findings, U-M Health ketamine clinic began recommending the use of highly-reliable contraception to patients who could become pregnant during treatment. Moving forward, efforts to establish best practices for the use of ketamine and esketamine in women of reproductive age are crucial to ensuring patient safety and preventing harm. The study emphasizes the need for improved consistency in reproductive counseling and monitoring to protect the well-being of patients undergoing ketamine therapy.