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This morning I read a paper presenting the opinions of the authors after they had undertaken a systematic review of the published evidence for the efficacy of ketamine (and esketamine) as maintenance treatment for depression.

I remain sceptical and in fact this paper supports my concern that there is a tendency toward misrepresentation. Very reasonably studies which they reviewed included almost only patients who had shown a response to ketamine in acute treatment, but had then relapsed. What is not quite so reasonable is regarding any use beyond four weeks as being maintenance treatment, rather than as continuation of acute treatment. The measure of good outcome is that symptoms have lessened in severity, not recovery to normal (for that person) function. 

After lunch I finished the next in the Ikmen crime novel series. Before going for a late afternoon walk. None of the photos I took while out on the footpaths was quite as pleasing as this shot of the flowers in one of the planters beside our front door.