- There are a growing number of ketamine clinics throughout the United States.
- There is substantial evidence that ketamine does have anti-depressant effects. How long these effects last is still unclear.
- The negative impacts of ketamine can prove both unpleasant and dangerous.
According to an article in the June 2022 issue of Psychiatry Research, "Replicated clinical trials have demonstrated rapid and robust antidepressant effects with ketamine in treatment-resistant mood disorders."
At the same time, with a growing number of clinics dispensing the psychedelic drug ketamine as a treatment for depression, a vital question arises. Is ketamine a breakthrough, or are so-called “ketamine cowboys” more interested in profits than in helping patients?
Former CNN medical correspondent Jeff Levine has been investigating this question. After visiting a ketamine clinic in New York City, Jeff agreed to an interview.
Susan: Jeff, what have you learned in your sleuthing about ketamine?
Jeff: Federal government and academic researchers have been studying ketamine for nearly two decades. Their studies suggest that ketamine does seem to alleviate severe depressive episodes.
At the same time, the trials have been small, with just a few patients and over a short time period. Dot ketamine’s effects last over time? Unclear. For instance, a recent study in France concluded that ketamine does help to prevent suicide in high-risk patients—but the study only followed the participants for six weeks.
In addition, some patients have reported adverse reactions to the drug. As Devon Frye pointed out in a Nov/Dec 2018 Psychology Today article, ketamine can induce hallucinations and also raise blood pressure. Higher doses can cause memory loss and bladder damage.
The bottom line: as of now, at least, ketamine is not FDA-approved to treat depression or other mental disorders.
Susan: Then why are so many ketamine clinics springing up?
Jeff: Ketamine “trips” have become a billion-dollar industry. The American Society of Ketamine Physicians, Psychotherapists, and Practitioners, a trade group boasting 400 members in the United States and 50 countries, declares that ketamine offers an alternative to older conventional drugs. Yes, ketamine does offer "an alternative." Whether that alternative works over the long term and what might be its side effects, however, still are unclear.
Susan: If ketamine hasn’t been officially approved for depression, how can medical professionals offer the treatment legally?
Jeff: Doctors have considerable latitude in how they prescribe medicine. Once a drug has been approved by the FDA for one purpose, physicians can dispense it “off-label” if they think it will help a particular patient’s problem. In the five decades since 1970, when ketamine was initially approved as an anesthetic, many doctors noticed that ketamine sometimes did have positive mental health impacts.
Susan: Then why aren't drug companies eagerly testing ketamine?
Jeff: Ketamine is off-patent, so it’s not profitable for a drug company to work to bring it to market. The exception is esketamine, a variation that has been approved for severe depression. Marketed as Spravato, it’s a nasal spray. While it’s been available for three years, it’s not widely used--perhaps because it must be administered in a doctor’s office under strict controls and also because it tends to be extremely expensive.
Susan: What is the incentive for the opening of so many ketamine clinics if the treatment has yet to be approved to treat mental illness?
Jeff: Profit can be a strong motive. The treatments can be very expensive. Ketamine is administered as an I-V. Each infusion can cost several hundred dollars. A course of six treatments, which is typical, can run $4,000 or more.
Susan: I’m curious, Jeff; what did you observe during your recent visit to a ketamine clinic?
Jeff: Nushama, located in a Manhattan high-rise, offers a multifaceted wellness treatment program assisted by ketamine that aims to reset a patient’s mood.
Cancer survivor Paula Echeverry, age 37, told me that her Nushama treatments produced “… a warm feeling that enters your whole being… makes you take a step back and feel like, okay, things are going to be like, okay.”
Nushama’s medical director Steven Radowitz, M.D. added, “Some people say it’s spiritual."
Note too that in recent months Nushama has lowered its pricing to make the resource accessible to more people who are suffering from a negative emotional state.
Susan: Do many psychiatrists and psychologists hold reservations about the treatment?
Jeff: Meg Chisolm, MD, a psychiatrist, educator, and author at Johns Hopkins, believes that while ketamine can be helpful when properly prescribed, patients can also use other resources to overcome most mental illnesses.
Dr. Chisolm especially expresses reservations about what she refers to as “flashy clinics.” As she explains, “Ketamine clinics are getting a lot of press. They have a lot of allure. And there’s money to be made. This happened with opioid pain medication. Pain mills were set up that made money off desperate people.”
Susan: I agree with Dr. Chisolm’s concern. Most depression is reactive, not purely chemical. That is, there is almost always an emotionally painful life incident that triggered the slide into a low and negative energy state. For this reason, mild to moderate levels of depression generally can be treated with more conventional methods such as CBT and/or the 3 P's visualization and other do-it-yourself methods I suggest in my book Prescriptions Without Pills.
At the same time, when depressive episodes are of severe intensity and duration and when they seem to have more of a biological basis, medication, including intervention with ketamine, can be life-saving.
So, Jeff, what do you conclude about ketamine treatments?
Jeff: Ketamine does offer at least some relief for many who suffer with depression. At the same time, Johns Hopkins’ researcher Sandeep Nayak offers this sobering perspective. “Certainly, there are ketamine cowboys out there. One thing I worry about is if you go to a ketamine clinic with a psychological problem, they're probably going to give you ketamine.”
The question is, do you really need it, or would something cheaper be just as good?
Susan: Thank you, Jeff!
KatieBenitahaAshley N.SiegelaOrlyLipsitzadNelson B.RodriguesadShakilaMeshkataYenaLeeaRodrigo B.MansuraFloraNasriaLeanna M.W.LuiaRoger S.McIntyreabcdefJoshua D.Rosenblatabd. Sex differences in ketamine's therapeutic effects for mood disorders: A systematic review Psychiatry Research, Volume 312, June 2022, 114579
Drug Des Devel Ther
Drug Des Devel Ther. 2019; 13: 3051–3067.
Published online 2019 Aug 27. doi: 10.2147/DDDT.S221437
Ketamine and depression: a narrative review
Alexandrine Corriger1,2 and Gisèle Pickering1,2