Intended for healthcare professionals

Rapid response to:


Esketamine for treatment resistant depression

BMJ 2019; 366 doi: (Published 23 September 2019) Cite this as: BMJ 2019;366:l5572


A drug not a miracle—why we need a new system for monitoring ketamine

Rapid Response:

Re: Esketamine for treatment resistant depression

In their latest reply, Jauhar and Morrisson seem to continue to rely on misrepresentation, distortion and obfuscation, all exaggerating the safety and efficacy of esketamine. Rather than continue to point out their latest errors we focus instead on the fact that they do not mention, let alone rebut, the crux of our response.

In their initial response they highlighted three references, from which the longest response to ketamine was reported just 18 days after treatment. We cited one very recent study of esketamine that they did not include, in which there was no difference from placebo on depression or suicide risk by day 25, but in which esketamine participants experienced nausea, dizziness, dissociation, unpleasant taste, and headache.

On this crucial evidence-based question, we have demonstrated, mainly using the references Jauhar and Morrisson cite in support of esketamine, why the available evidence finds that it is more likely to harm than benefit patients with resistant depression. Thus, the only reasonable and ethical evidence-based conclusion is that this drug should not be used in clinical practice but only as an experimental drug in randomised trials of adequate length, with long-term follow up, and with patient relevant outcomes assessing both harms and benefits.

It is regretful that Jauhar and Morrison seem to have chosen to pull out of this debate without addressing our substantive points.

Competing interests: No competing interests

22 October 2019
Peter C Gøtzsche
Michael P Hengartner, James Davies, John Read, Anne Guy, Sami Timimi and Peter Kinderman, all from the Council for Evidence-based Psychiatry
Institute for Scientific Freedom, Copenhagen