Racial-Ethnic Disparities in Ketamine and Esketamine Therapy for Major Depressive Disorder.

Objective: This study sought to investigate racial-ethnic disparities in the utilization of intravenous ketamine and intranasal esketamine therapy for major depressive disorder.

Methods: The TriNetX platform was used to identify 861,179 patients diagnosed as having moderate-to-severe recurrent major depressive disorder between January 2019 and October 2024. Patients were divided into non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic cohorts. Propensity score matching (PSM) was used to match minority cohorts with White patients. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated to compare ketamine and esketamine utilization across racial-ethnic groups.

Results: After PSM, the authors found that ketamine was prescribed at lower rates among Black (RR=0.75, 95% CI=0.72-0.78), Hispanic (RR=0.71, 95% CI=0.68-0.75), and Asian (RR=0.65, 95% CI=0.57-0.75) patients compared with White patients. Esketamine was utilized at lower rates among Black patients (RR=0.74, 95% CI=0.62-0.88) and at higher rates among Hispanic patients (RR=1.45, 95% CI=1.24-1.69), whereas Asian patients showed no significant difference. Within-group comparison among Black and White patients found that individuals who received ketamine or esketamine in both cohorts had more comorbid general medical and psychiatric conditions than those who did not.

Conclusions: Significant racial-ethnic disparities exist in the utilization of ketamine and esketamine therapies for major depressive disorder, particularly affecting Black patients. Future research should investigate the underlying causes of these disparities and develop strategies to ensure equitable access to ketamine and esketamine for all patients with major depressive disorder.