To the Editor In their presentation of guidelines for the use of ketamine in mood disorders, Sanacora et al¹ rightly state that ketamine is not standard treatment in psychiatry but then inexplicably refer to 0.5 mg/kg intravenously over 40 minutes as the “standard” dose. How can there be a standard dose for a nonstandard treatment? A brief review of the history of this dosing method is instructive. The first to use this dosing format for depression was Berman et al,² who did not provide any rationale. They did cite Krystal et al,³ who used 0.5 mg/kg intravenously over 40 minutes for studies of ketamine in normal volunteers. In turn, that group cited, as a basis for this dosage and infusion rate, the classic studies of Domino et al⁴ and Corssen and Domino.⁵ However, those investigators infused ketamine over a few seconds to 1 minute. Thus, it would seem that the now familiar 0.5 mg/kg over 40 minutes is arbitrary, without any pharmacodynamic or pharmacokinetic rationale.

致编辑 在介绍氯胺酮治疗情绪障碍的指南时，Sanacora 等人¹正确地指出氯胺酮不是精神病学的标准治疗，但随后莫名其妙地将 40 分钟内静脉注射 0.5 mg/kg 称为“标准”剂量. 非标准治疗怎么会有标准剂量？简要回顾一下这种给药方法的历史是有益的。第一个使用这种给药方式治疗抑郁症的是 Berman 等人²，他们没有提供任何理由。他们确实引用了 Krystal 等人[ ³ ]，他们在 40 分钟内静脉内使用 0.5 mg/kg 对正常志愿者进行氯胺酮研究。反过来，该小组引用了 Domino 等人^{4的经典研究作为该剂量和输注速度的基础}还有科森和多米诺骨牌。⁵然而，这些研究人员在几秒钟到 1 分钟内注入了氯胺酮。因此，现在熟悉的 40 分钟内 0.5 mg/kg 似乎是任意的，没有任何药效学或药代动力学原理。