MHM Magazine

limitations. • The clinician should clarify that ketamine is off-label for depression under SAHPRA. • The patient should be given time to ask questions, consider implications, and voluntarily choose ketamine, ensuring transparency rather than implying equivalence with ECT. • The psychiatrist failed to disclose the empirical evidence regarding potential side effects, such as urinary incontinence associated with prolonged ketamine use. The breach of fiduciary duty could potentially lead to legal repercussions if the patient were to experience adverse effects, such as urinary incontinence. • There appears to be a potential financial conflict of interest, as the psychiatrist may be associated with the private ketamine practice or may be receiving a personal commission. • Charges are exorbitant for repeated off-label ketamine infusion and are usually not covered by medical aid, far exceeding the cost of other available treatment options. • The psychiatrist also neglected the principle of fidelity, which is rooted in the ethical duty to provide genuine care to patients. Beneficence • Beneficence encompasses not just symptom remission but also real-world functioning- here, the goal being to return to work. Continuation of psychotherapy and follow-up is arranged, demonstrating a holistic therapeutic plan, not a transactional intervention. Non-maleficence The clinician should discuss the potential harms of ketamine therapy and acknowledge the financial burden of repeated therapies. Justice The psychiatrist should inform the patient that ECT is readily available, while ketamine therapy is costly. The clinician offered a ketamine therapy referral despite knowing the financial burden that may limit her ability to access care. Conclusion The promise of ketamine as a transformative treatment for mood disorders holds great potential, yet it’s our ethical responsibility as practitioners to ensure that patient welfare remains at the forefront of its integration into psychiatric practice. Clinicians are urged to reduce the risk of patient harm by carefully considering the available evidence on ketamine and ensuring that all standard antidepressant treatments have been attempted before using ketamine off-label. References available on request. MHM | 2025 | Volume 12 | Issue 5 | Evaluating the ethical implications of off-label ketamine use in clinical practice MHM 22 | MENTAL HEALTH MATTERS | 2025 | Issue 5 H