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An intranasal formulation of (S)\u2010ketamine was recently approved by the US Food and Drug Administration (FDA) to be used in individuals with treatment\u2010resistant depression (TRD). There are no data directly comparing outcomes on depression or other comorbidities between these two formulations of ketamine. However, recent meta\u2010analyses have suggested that IV racemic ketamine may be more potent than IN\u2010(S)\u2010ketamine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively analyzed clinical outcomes in 15 Veterans with comorbid TRD and post\u2010traumatic stress disorder (PTSD) who underwent ketamine treatment at the VA San Diego Neuromodulation Clinic. All Veterans included in this analysis were given at least 6 intranasal (IN)\u2010(S)\u2010ketamine treatments prior to switching to treatment with IV racemic ketamine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Veterans receiving ketamine treatment ( across both IN\u2010(S)\u2010ketamine and IV\u2010(R,S)\u2010ketamine) showed significant reductions in both the Patient Health Questionnaire\u20109 (PHQ\u20109), a self\u2010report scale measuring depression symptoms (rm ANOVA <jats:italic>F<\/jats:italic>(14,42)\u00a0=\u00a012.6, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.0001), and in the PTSD checklist for DSM\u20105 (PCL\u20105), a self\u2010report scale measuring PSTD symptoms (rm ANOVA <jats:italic>F<\/jats:italic>(13,39)\u00a0=\u00a05.9, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.006). Post hoc testing revealed that PHQ\u20109 scores were reduced by an average of 2.4\u00a0\u00b1\u00a01.2 compared to baseline after (S)\u2010ketamine treatments (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.1) and by an average of 5.6\u00a0\u00b1\u00a01 after IV\u2010ketamine treatments (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.0003) compared to pretreatment baseline scores. PCL\u20105 scores were reduced by an average of 4.3\u00a0\u00b1\u00a03.3 after IN (S)\u2010ketamine treatments (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.6) and 11.8\u00a0\u00b1\u00a03.5 after IV\u2010ketamine treatments (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.03) compared to pretreatment baseline scores.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This work suggests that off\u2010label IV\u2010(R,S)\u2010ketamine could be considered a reasonable next step in patients who do not respond adequately to the FDA\u2010approved IN\u2010(S)\u2010ketamine. Further double\u2010blinded, randomized controlled trials are warranted to assess whether IV racemic ketamine is more effective than IN\u2010(S)\u2010ketamine.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.2664","type":"journal-article","created":{"date-parts":[[2022,2,5]],"date-time":"2022-02-05T04:36:55Z","timestamp":1644035815000},"page":"272-279","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Response to intravenous racemic ketamine after switch from intranasal (S)\u2010ketamine on symptoms of treatment\u2010resistant depression and post\u2010traumatic stress disorder in Veterans: A retrospective case series"],"prefix":"10.1002","volume":"42","author":[{"given":"Sean","family":"Bentley","sequence":"first","affiliation":[{"name":"Department of Psychiatry UC San Diego La Jolla California USA"},{"name":"Mental Health Service VA San Diego Healthcare Syst. 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