Ketamine is an old drug (first synthesized in 1962), but may have an extremely auspicious future. On the street, this dissociative hallucinogenic is commonly referred to as “Special K”. It was the most commonly used anesthetic in the Vietnam War, and is still frequently used in hospitals and veterinary clinics for this purpose. Now, a growing body of groundbreaking research is showing that Ketamine could potentially revolutionize the mental health field. The hype is real, so what’s making Special-K seem so special?
The growing excitement over Ketamine centers on its potential to be the first ever rapid-acting antidepressant. Recent research has shown Ketamine to produce antidepressant effects within 40 minutes, contrasting sharply with typical antidepressants which can take several weeks before they start working. If you’re at all familiar with depression, it should be clear just how brutal even a short period of time without relief can be. Studies have shown that in the weeks immediately following an initial administration of antidepressants, risk of suicide actually increases. When a person is even considering taking their own life, every minute counts, and they may not have a few weeks to wait before their standard antidepressants begin to work. Here, in the moments where immediate relief from suicidal thoughts is desperately needed, Ketamine’s rapid-acting antidepressant nature may have the biggest impact. As we learn more about how Ketamine interacts with the body, we are gaining a deeper understanding for how the drug could also be used as an adjunct to many other treatments, such as for PTSD and addiction.
As incredible as Ketamine’s benefits may look, the drug is also rife with possible drawbacks that range from bladder problems, to memory issues, to symptoms akin to that of schizophrenia. It is extremely dangerous to take without professional monitoring as the risk of side effects increases drastically when not taken at highly controlled, low, therapeutic doses, and it has a high potential for abuse, rapid development of tolerance, and psychological dependence.
Currently the FDA has only approved Ketamine to be administered via injection, thus further necessitating professional supervision every time a dose is taken. The potential benefits of Ketamine can last from days, to weeks, to months, but it is not a cure for depression, just an ongoing treatment which necessitates repeated administrations of the drug. It isn’t the drug that is expensive, it’s the current route of administration. Each of these administrations at a Ketamine clinic can cost hundreds of dollars, and insurance companies aren’t typically reimbursing for it yet. So, along with being potentially detrimental to one’s health, Ketamine treatment currently takes a big toll on one’s finances as well.
Large-scale, systematic, psychiatric research on Ketamine has been scatter-shot and inconsistent over the past 20 years, which means we’re still in the early stages of testing. The FDA has only approved it for one-time use as an anesthetic, not the long-term, repeated use needed in treatment of depression. This leaves much uncertainty about what the long-term effects of its use could be. Since Ketamine is off patent, pharmaceutical companies don’t have financial incentive to pay for large-scale studies, thus limiting data on the drug. Recently, however, the FDA has labeled two Ketamine offshoots, Esketamine and Ranitidine, as “breakthrough therapies”, giving them the fast track towards approval. We could end up seeing one of these drugs getting the FDA green-light for treatment of depression as soon as 2018. Both drugs, in fact, would most likely end up trumping Ketamine in the long run. They are backed by pharmaceutical companies who have funds to support the studies it would take to get them FDA approved. That approval, coupled with the likelihood that neither will need to be injected (Intranasal Esketamine is currently being developed, along with an orally-administrable version of Ranitidine), will make them much more likely to be covered by insurance than pure Ketamine ever will.
There are so many reasons why Ketamine’s hype seems to be justified. More frequent and adventurous research is generating a good amount of the buzz, but now there are also thousands of patients who have been successfully treated at Ketamine clinics around the country, adding to the public awareness and anecdotal evidence. Despite these clinical successes, Ketamine has a long and well-documented history of serious problems and hazards, and should be left as a last resort for only the most treatment-resistant individuals. When one doctor (Gerard Sanacora, MD, PhD) was asked about how he could, in good-conscience, prescribe potentially risky Ketamine treatment to his patients, he offered a valuable point: “If you have patients that are likely to seriously injure themselves or kill themselves within a short period of time, and they’ve tried the standard treatments, how do you not offer this treatment?” With two Ketamine-based drugs potentially being placed on the market within the next year, we should be prepared for what could be a revolution in psychiatric care. We at Mainstream are cautiously optimistic about what this drug could do for the field of mental health, and there are many doctors out there that are getting excited as well. Here’s what some of them are saying about Ketamine:
“It is potentially the most exciting development in my lifetime for the treatment of mood disorders” – Gerard Sanacora, MD, PhD, director of the Depression Research Program at Yale University.
“It’s not uncommon for people to sit in my office and say, ‘Dr. Brooks, this is the first time I’ve gotten out of bed in a week” –Glen Brooks, MD, an anesthesiologist and medical director of NY Ketamine Infusions
“This is probably the most interesting and exciting new development that I’ve seen in my career, and probably going back over the past 50 to 60 years,”- James Murrough, MD, an assistant professor of psychiatry and neuroscience at the Icahn School of Medicine at Mt. Sinai in New York.
“In the past 20 years, I’ve not seen anything like this” –Cristina Cusin, MD, a clinician and researcher who runs the ketamine clinic at Massachusetts General Hospital
“It’s been a paradigm shift, that now we can achieve rapid antidepressant effects… Now we know there’s something radically different.”-Carlos Zarate MD, chief of the experimental therapeutics and pathophysiology branch at the National Institute of Mental Health and one of the foremost researchers of ketamine.
“Psychiatry has never seen a drug intervention so powerful and fast acting.” – Jack Turban, MD
“The most important breakthrough in antidepressant treatment in decades.” – The National Institute of Mental Health
- Inaba, Darryl, and William E. Cohen. Uppers, Downers, All Arounders: Physical and Mental Effects of Psychoactive Drugs. 6th ed., 2007.
This content has been provided purely for informational purposes. Mainstream has no financial stake in the popularization of Ketamine treatment or any Ketamine-based treatment. Treatment of any medical or psychiatric condition needs to be discussed with and supervised by medical and psychiatric professionals.