Innovative Depression Treatment: Ketamine Therapy Gains Popularity, But Raises Concerns

Rising Ketamine Usage Leads to Chaotic Health Care Landscape

Ketamine use skyrockets, creating healthcare chaos. It’s like the wild west out there!

Nov. 27, 2023 — On a drizzly Wednesday afternoon, Christopher sat in an overstuffed reclining chair, cocooned in a cozy blanket after his most recent infusion at the Ketamine Healing Clinic of Los Angeles. Diagnosed with depression at age 19, Christopher (not his real name), a 35-year-old graduate student, has battled treatment-resistant depression for years.

He rattled off the list of treatments he’s tried, both conventional and alternative: Lithium, Wellbutrin, Paxil, other antidepressants, mushrooms, meditation, cognitive behavioral therapy. None of them provided long-term relief, and some even dulled his emotions. “I became more robotic, less social,” he quipped.

But ketamine is different. Christopher has found some relief, some self-acceptance, and is much less hard on himself. It’s like a breath of fresh air after being suffocated by depression. The treatment has made it easier for him to exercise and be social, two recommended strategies for alleviating depression.

Sure, ketamine therapy comes with a hefty price tag ($700 for a single session), and insurance rarely covers it, but Christopher believes it’s worth every penny. He’d never consider ordering ketamine for home use via a telehealth platform. “You don’t know where it comes from,” he said, shaking his head.

The Rise of Ketamine Clinics: Popularity vs. Controversy

In recent years, ketamine clinics and the access to ketamine have become more common in the U.S. No one knows the exact number of these clinics, but it’s estimated to be around 700 to 800. The number of patients with a ketamine prescription has skyrocketed by more than fivefold from 2017 to 2022. The pandemic further fueled the growth of online access to ketamine via telemedicine, thanks to the temporary loosening of restrictions by the Drug Enforcement Administration. This flexibility has been extended until 2024.

However, amidst the popularity, concerns and controversies abound. The FDA has warned about compounded ketamine and its risks, while deceptive advertising practices have been discovered on telemedicine platforms. Additionally, doctors and advocates of ketamine struggle to navigate through an unregulated system, calling for regulation, oversight, and possibly a registry.

The question remains: How can this Wild West be tamed?

Ketamine: An FDA and DEA Conundrum

Ketamine, a Schedule III controlled substance, is FDA-approved solely for general anesthesia and not for any psychiatric disorders. The DEA acknowledges its potential for abuse, as it is also used as a party or club drug, known as K or Super K. The FDA did approve esketamine, a nasal spray called Spravato, for treatment-resistant depression in 2019, but access to it is limited to certified doctor’s offices or clinics.

In an October 10th FDA warning, the agency highlighted potential risks associated with ketamine, including oral formulations, for psychiatric disorder treatments. The message emphasized that ketamine is not approved by the FDA for any psychiatric disorder and raised concerns about safety issues, misuse, and abuse. The FDA made it clear that there’s no evidence suggesting ketamine is safer, more effective, or faster-acting than FDA-approved medications for treating psychiatric disorders.

Ketamine: Praised by Prescribers, Valued by Patients

Although ketamine is often used off-label for depression, it is also utilized for anxiety, PTSD, binge eating, and addiction at various clinics. Protocols differ, but one example is six infusions over three weeks, sometimes accompanied by music and incorporated talk therapy.

Dr. Steven Radowitz, an internal medicine doctor and co-founder of Nushama Psychedelic Wellness Center in NYC, explains that ketamine creates a neuroplastic process in the brain, allowing patients to process and reframe their views on life. The treatment provides a free-flowing and organic approach, increasing the brain’s functional capacity. Dr. David Mahjoubi of the Ketamine Healing Clinic of LA also affirms that ketamine can enhance connections between neurons, leading to increased motivation and decreased apathy.

While the cost of ketamine therapy can be steep, patients often find it worth it. Some clinics offer flexible payment options, while telehealth programs like Mindbloom provide clinician input and guidance for at-home ketamine use. Dr. Katharine Grace Marder of UC Davis Health System supports the use of ketamine for major depressive disorder and potentially bipolar disorder, but advises against home use due to insufficient evidence regarding its benefits and risks.

Ketamine Research: Hopeful Findings

Recent studies have shown promising results for ketamine research. In a study published in the New England Journal of Medicine, researchers found ketamine to be comparable to electroconvulsive therapy for treatment-resistant major depression. Another study sponsored by Mindbloom demonstrated the safety and efficacy of oral ketamine in treating moderate to severe anxiety and depression.

The Snake Oil Salesmen: Issues with Online Advertising

Direct-to-consumer advertising of ketamine has come under scrutiny due to numerous misleading claims about safety and efficacy. Researchers from Johns Hopkins University and the University of Colorado discovered misleading statements made by ketamine clinics in online advertisements. The researchers are expanding their research nationally, aiming to bring more transparency to the marketplace.

Patient Stories: Tales of Triumph and Caution

While some individuals have had positive experiences with ketamine therapy, others have had mixed results. One anonymous former ketamine user found the therapy ineffective for their PTSD diagnosis, even leading to hospitalization after their third session. They now believe that more research is needed to determine ketamine’s effectiveness for PTSD.

On the other hand, Jessa Common, diagnosed with PTSD after being present at the finish line of the 2013 Boston Marathon bombing, found solace in ketamine therapy. It allowed her to see her life and traumas as part of a larger story, giving her a sense of spiritual connection. Although her life may seem less impressive on paper, she emphasizes that she’s much happier now.

The Quest for Regulation and Standards

While the potential benefits of ketamine therapy are evident, the field urgently requires regulation, oversight, and clear standards. Medical boards, in collaboration with the FDA, should work to implement regulations for clinics and define the necessary presence of healthcare providers during infusions.

In the meantime, ketamine therapy continues to provide hope, transforming lives that were previously trapped in the grip of depression. As we strive for better regulation and research, the journey towards unlocking the full potential of ketamine therapy continues.

What are your thoughts on ketamine therapy? Have you or someone you know had experiences with it? Share your stories and perspectives in the comments below!