Psych CASC / OSCE · Psychopharmacology — ketamine and esketamine
Explaining esketamine for TRD and safety rules (CASC)
CASC-style communication station: shared decision on esketamine after failed antidepressants, supervised dosing, observation, realistic benefits and risks, and ECT comparison.
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Station instructions (candidate)
You have 7 minutes. Explain why esketamine is being considered after multiple adequate antidepressant failures, how supervised clinic dosing works (not take-home), what happens in the observation period, common short-term effects (dissociation, nausea, blood-pressure rise), and how this differs from recreational ketamine harm. Compare with ECT using ELEKT-D-level honesty for nonpsychotic TRD without declaring ECT obsolete. Do not guarantee cure. Do not minimise addiction/diversion concerns — explain clinic controls.[1][2][3][4][5]
References5ShowHide
- [1]Popova V, Daly EJ, Trivedi M, et al. Efficacy and Safety of Flexibly Dosed Esketamine Nasal Spray Combined With a Newly Initiated Oral Antidepressant in Treatment-Resistant Depression: A Randomized Double-Blind Active-Controlled Study. Am J Psychiatry, 2019.PMID 31109201
- [2]Daly EJ, Trivedi MH, Janik A, et al. Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment for Relapse Prevention in Patients With Treatment-Resistant Depression: A Randomized Clinical Trial. JAMA Psychiatry, 2019.PMID 31166571
- [3]Short B, Fong J, Galvez V, et al. Side-effects associated with ketamine use in depression: a systematic review. Lancet Psychiatry, 2018.PMID 28757132
- [4]Anand A, Mathew SJ, Sanacora G, et al. Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression. N Engl J Med, 2023.PMID 37224232
- [5]McIntyre RS, Rosenblat JD, Nemeroff CB, et al. Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation. Am J Psychiatry, 2021.PMID 33726522