Ketamine Postpartum in WSJ

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randomdoc1

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I'm glad more discussion is being had about this in a critique lens. It's a terrible tragedy but hopefully sheds perspective on need for judicious use and it's not a miracle worker. From WSJ.

---When 32-year-old Tranyelle Harshman sought help in late 2024 for postpartum depression from Sage Psychiatry Services, a provider in Wyoming, a nurse practitioner named Krista Blough met her in person and prescribed ketamine lozenges for Harshman to take at home.
Harshman suffered heart palpitations, had difficulty focusing, and felt disconnected from reality for days after taking the drug.
Harshman was scared, but Blough told her that such side effects were common at first and increased her dose, according to Harshman’s mother, Rhonda Coplen.
On Feb. 10 of last year, Harshman scheduled playdates for her four girls, ages 2 to 8, and put them down for a nap. Then she took her increased dose of ketamine.
Soon afterward, in an eerily emotionless voice, Harshman called 911 and told the emergency responder that she had shot and killed her four daughters and was about to kill herself too, according to a 911 recording reviewed by the Journal. She told the operator that someone had been trying to take her girls, and it was easiest if everyone went at once.
All five died. Harshman had no history of violence or suicidal thoughts, Coplen said.
Harshman’s toxicology report, which was reviewed by the Journal, shows that the level of ketamine in her blood was more than four times the threshold reported in studies for mind-altering effects and physical impairment. Some medical reports suggest that patients could be prone to violent behavior under the drug’s influence or coming off it, since they are dissociated from reality.
“She was a good mom and loved her girls,” said Coplen, who filed a lawsuit against Sage Psychiatry and Blough alleging wrongful death. She said she believes ketamine has a purpose, but “it is reckless to allow it to be in a setting where you don’t have clinical supervision.
In a legal filing in November, lawyers for Sage Psychiatry and Blough said that they didn’t cause the tragedy, adding that the “injuries and damages” may have been caused by third parties or from pre-existing conditions, and that Harshman was “adequately informed of the risks, benefits and alternatives of the treatment and gave their consent based on that information.”
Ketamine is now at the heart of a largely unregulated online industry offering depression relief.
More than a million Americans used ketamine in 2024, legally or not, twice as many as in 2021, according to federal data. Prescriptions dispensed by pharmacies, including for at-home use, rose more than eightfold in the first nine months of 2025 compared with all of 2024, according to the Iqvia Institute for Human Data Science.
Evidence is mounting of ketamine’s potential dangers. ---

 
Unfortunately this is not very good reporting. The article tries to make it sound like this is all ketamine and it’s probably more complex. This was a woman with a long history of depression and ptsd. She has her last child in 2023 then had a hysterectomy and the incident happens in 2025. She was also on clonazepam and drank alcohol while on these meds. She had tried numerous treatments before apparently. Very hard to get good care in Wyoming. The NP was out of her depth. You have to wonder about a psychotic depression. I also question why they say she had postpartum depression when she was post-menopausal.

Very sad story.
 
Unfortunately this is not very good reporting. The article tries to make it sound like this is all ketamine and it’s probably more complex. This was a woman with a long history of depression and ptsd. She has her last child in 2023 then had a hysterectomy and the incident happens in 2025. She was also on clonazepam and drank alcohol while on these meds. She had tried numerous treatments before apparently. Very hard to get good care in Wyoming. The NP was out of her depth. You have to wonder about a psychotic depression. I also question why they say she had postpartum depression when she was post-menopausal.

Very sad story.
yes, either way, it's an unfortunate outcome. End of the day, when patients come inquiring about options for treatment resistant cases, all the more reason for someone highly trained to weigh in. These cases come with tremendous complexity that warrant excellent diagnostics. I think we can both agree that ketamine is getting out of hand. Complex cases warrant a deep dive and thorough treatment planning either way.
 
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Unfortunately this is not very good reporting. The article tries to make it sound like this is all ketamine and it’s probably more complex. This was a woman with a long history of depression and ptsd. She has her last child in 2023 then had a hysterectomy and the incident happens in 2025. She was also on clonazepam and drank alcohol while on these meds. She had tried numerous treatments before apparently. Very hard to get good care in Wyoming. The NP was out of her depth. You have to wonder about a psychotic depression. I also question why they say she had postpartum depression when she was post-menopausal.

Very sad story.

I mean if she was actually being prescribed clonazepam at the same time this NP prescribed her at home ketamine lozenges and then increased the dose when she reported side effects, I'm surprised they aren't settling right now.

It's certainly not the only factor but I'm assuming you'd get expert witnesses lining up to state that this is below standard of care.
 
I mean if she was actually being prescribed clonazepam at the same time this NP prescribed her at home ketamine lozenges and then increased the dose when she reported side effects, I'm surprised they aren't settling right now.

It's certainly not the only factor but I'm assuming you'd get expert witnesses lining up to state that this is below standard of care.
Cue everyone on here that argues, “but, but, standard of care for NPs is different!!”
 
I have worked with psychiatrists who administer ketamine and it is done in their office in a safe manner. Given the fact that post-partum depression can lead to psychosis and occasionally dead infants, I have always been a little extra careful when working with these patients. In other words, I would definitely not refer for ketamine treatment to an NP who hands out lozenges and would document my discussion about risks and other recommendations I would make. Referral to a psychiatrist I know who might treat with ketamine and communication or coordination with him and other supports. The patients family would be much less likely to sue if they had been engaged in the process as supports. If there is no family support or patient is unwilling to engage them then I document that.
 
Is there any concern about increased risk of ketamine induced uropathy in post partum individuals?

I'm not a physician or anything, but I would think that: one thing that makes you pee weird + another thing that makes you pee weird=bad.

*aside from all the murder
 
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Is there any concern about increased risk of ketamine induced uropathy in post partum individuals?

I'm not a physician or anything, but I would think that: one thing that makes you pee weird + another thing that makes you pee weird=bad.

*aside from all the murder

I also don't do anything regularly with ketamine anymore but from my understanding previously ketamine induced cystitis is mostly from recreational high dose frequent use. It was always a theoretical concern with outpatient IV infusions that we had to tell people about when I rotated there in residency but not something they actually saw (I don't know if at all, certainly not frequently).

Now does that matter more with daily lozenges vs monthly IV injections? Who knows. Also "take home" ketamine like this is much more suspectible to overuse of course....look at how easy it was for this NP to go "lets just increase the dose if it isn't working".
 
I also don't do anything regularly with ketamine anymore but from my understanding previously ketamine induced cystitis is mostly from recreational high dose frequent use. It was always a theoretical concern with outpatient IV infusions that we had to tell people about when I rotated there in residency but not something they actually saw (I don't know if at all, certainly not frequently).

Now does that matter more with daily lozenges vs monthly IV injections? Who knows. Also "take home" ketamine like this is much more suspectible to overuse of course....look at how easy it was for this NP to go "lets just increase the dose if it isn't working".
I've only seen these cases from high dose usage as well. Definitely a concern with the take-home ketamine from your online NP drug-dealer, erm "provider" though.