A draft of Scott's Lorien Psychiatry clinical guide to ketamine for depression, posted for reader peer review — but the content is complete and exceptionally practical. It lays out the three access routes (expensive IV clinics ~$4800/course, FDA-approved esketamine/Spravato ~$6400/month, vs cheap off-label compounded oral/nasal ketamine ~$10/dose) and forcefully advocates the cheap route, explaining the esketamine-is-a-patent-workaround dynamic. It works through safety systematically (cognitive, urinary, hepatic, addiction, hypertension side effects) with the crucial recreational-vs-clinical-dose 'the dose makes the poison' framing (recreational abusers take ~7000g lifetime vs ~3g for a clinical course), gives effectiveness numbers (effect size 0.6-1.0 vs SSRIs' 0.3), compares routes, provides actual step-by-step dosing instructions, covers the poorly-studied maintenance/duration question, distinguishes purely-biochemical ketamine from ketamine-assisted psychotherapy, and explains the AMPA/BDNF-over-NMDA mechanism. A genuinely useful, evidence-based, actionable resource.

Quality 75 · Excellent. Excellent-floor (75). A comprehensive, rigorous, and genuinely actionable clinical guide with real public-health value (helping patients access cheap effective treatment), among Scott's best practical psychopharmacology writing; the reference/FAQ format and peer-review-draft framing keep it just off the higher tiers, but the utility and thoroughness are exceptional.

Claude’s paradigm shift 52 · Moderate. Moderate (52). The cheap-compounded-ketamine advocacy and the practical synthesis are useful and somewhat contrarian, but it consolidates existing evidence rather than installing a new frame.

Real-world impact 2 · Minor. 2 — an actionable clinical guide (part of the public Lorien Psychiatry resource) that could plausibly change some real prescribing/access decisions and treatment costs; real but modest and hard to quantify.

Peer Review Request: Ketamine