By Melinda Young
OB/GYNs and other reproductive healthcare providers need to find out during contraceptive and pregnancy counseling whether their patients are using or have plans to use ketamine, a drug that is becoming more common for use among psychiatric patients, new research says.1
Ketamine helps reduce depressive symptoms and suicidal ideation among patients who have treatment-resistant depression.1
But the drug, which has been studied in animal models, has the potential to affect neurodevelopment in human embryos and fetuses. Ketamine rapidly crosses the human blood-placental barrier. Animal offspring exposed to ketamine in the prenatal period have had lasting behavioral, cognitive, and affective disturbances. In primates, ketamine use during pregnancy causes neurodegeneration apoptosis in the fetal brain and long-lasting cognitive deficits.1
Contraception should be strongly considered for the majority of patients who could potentially get pregnant while being treated with ketamine, says Rachel Pacilio, MD, a clinical assistant professor in psychiatry in the department of psychiatry at Michigan Medicine, University of Michigan in Ann Arbor.
“We don’t have data specifically about this [in humans], but in animal studies what we’re most concerned about is early in development — first and second trimester — related to neurodevelopment that goes on in that period,” she explains. “In animal studies, ketamine is used to induce mild schizophrenia for animals in studies.”
There are more than 500 ketamine clinics in the United States, where patients may receive ketamine intravenously (IV) twice a week for several weeks. But 60% of ketamine clinics estimate their average maintenance course duration is longer than six months.1
Spravato is a Food and Drug Administration-approved medication using ketamine that is administered as a nasal spray twice a week for four weeks. A person could be receiving ketamine treatment before they even know they are pregnant, and it still could be a danger to the embryo’s development, she says.
“There are no case studies that we were able to find,” Pacilio notes. “We were able to find a couple of cases where PCP [phencyclidine], which is a similar substance, and there was more information about how PCP was associated with neonatal withdrawal syndrome and behavioral abnormalities in infants.”
Psychiatrists and other physicians who prescribe ketamine have a responsibility to make certain patients are aware of the risks and are offered a referral to a family doctor or OB/GYN for contraception.
Since ketamine is a relatively new intervention in psychiatry, it also is important for OB/GYNs and reproductive healthcare clinicians to be aware of its potential use and the need for patients to have access to contraception before they start using the drug.
“One of our goals with the study is to get the information out so non-psychiatrists will be aware of this risk,” Pacilio says.
“It’s not always apparent to providers that patients are getting this medication, and it may not show up in regular electronic health records because they may be getting treatment in other places,” she explains. “Patients may not think to add ketamine to a medication list, so asking about that if the patient has a history of depression or taking other psychotropic medications is important.”
If a patient is taking ketamine and has the potential to become pregnant without a pregnancy intention, providers can recommend contraception and start that to prevent pregnancy.
“If someone is thinking about getting pregnant or wants to get pregnant in the near future, then figure out with the prescribing clinician how long they think the ketamine course may be and figure out a way to prevent pregnancy while the patient is still receiving the treatment,” Pacilio suggests. “Then the patient can transition to [another psychiatric medication] that is safe in pregnancy while they are trying to conceive.”
Reference
- Pacilio RM, Lopez JF, Parikh SV, et al. Safe ketamine use and pregnancy: A nationwide survey and retrospective review of informed consent, counseling, and testing practices. J Clin Psychiatry 2024;85:24m15293.
