The first question kind of coming in is, could you comment where you may place various treatments in a treatment sequence of available interventions based on available data, i.e., is there an algorithm? And secondarily, for everyday clinician, what do you recommend for some type of rating scale to kind of monitor response and remission? So I, to answer the first question, where it fits in the algorithm, I think it does have to be personalized to some extent. I think in general, for me, this is not a first line treatment, probably not even a second line. I think this is probably something that I would be turning to when I'm considering ECT. We're doing a large study. There's a large study sponsored by PCORI that is sponsored through the Cleveland Clinic, where it's a head-to-head study, ECT versus ketamine, and I think we'll have the results for that probably within the next two years, and we'll be able to see how it stands up to ECT. But in general, I think this is a treatment that is not, and even the current FDA indication is for people that have failed at least two previous antidepressants, standard oral antidepressants. I think that's a reasonable spot. Obviously, if there's an imminent risk of suicidism, it may enter into the equation somewhat there. In terms of a rating scale, if you can't do something like a Madras or a Hamilton, there are rating scales. Even the PHQ-9 may have some benefit, some of the patient rating scales or what's called the QIDS SR-16, which is a self-report. I think any of them, as long as they're used consistently, and really the patient understands what they're doing and you take the time to do those rating scales. I am a huge advocate of evidence-based and measurement-based care. That makes sense. And one last question, we'll make it a rapid-fire question, for maintenance infusions in the era of COVID-19 and rescheduling elective procedures, how have you approached ketamine infusion? Delay entail urgency or possible clinical decompensation, or is it business as usual? This is where I've been spending most of my time over the past month, month and a half. At our site, we've taken the level and taken some lead from our ambulatory surgery clinics. We've really come to the point where if it is possible to delay treatment or reduce the number of treatments, we do. We have a criteria where if you're not in urgent risk of either being hospitalized or potentially having some self-harm, we really are trying to delay the treatments at this point. Got it. But we are still offering treatments in a very careful manner, which I assume most people are doing. At least we're in Connecticut, which is a high-impact area. Yeah. That's a good answer. So I think that's all the time for questions we have.

ketamine treatment

interventions algorithm

ECT vs ketamine study

rating scales for response monitoring

maintenance infusions during COVID-19