A psychiatrist reflects on two decades of treating depression with ketamine

Psychiatrist Muhamad Aly Rifai discusses his article "A psychiatrist's 20-year journey with ketamine." Aly recounts his first encounters with ketamine at the National Institute of Mental Health, where its rapid impact on despair reshaped his understanding of depression treatment. He explains the neurobiologic mechanisms, the shift from research to real-world practice, and the FDA's evolving stance on esketamine and off-label IV ketamine. Aly emphasizes the importance of pairing ketamine with psychotherapy, screening patients carefully, and honoring both the power and limitations of this intervention. He also highlights access challenges, safety concerns, and the need for clinicians to build structured protocols. Listeners will take away a nuanced view of ketamine not as a miracle cure but as a catalyst for healing when embedded in comprehensive, patient-centered care.

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