Psychedelic drug therapy has put ketamine in the spotlight
Ketamine is an anesthetic used to sedate both humans and pets, and it’s a favorite of party goers seeking a psychedelic high. Now it’s also the subject of an enormous amount of interest as a fast-acting treatment for depression and other serious mental health conditions.
Despite all the buzz about ketamine’s therapeutic potential, people remain confused about how it works and how to find a doctor who prescribes it. We interviewed psychiatrists, other experts, and patients to answer 10 common reader questions about ketamine. Here’s what they had to say.
Ketamine – Who is most likely to benefit from it?
Treatment with ketamine is generally intended for people who have a severe mental illness and have tried other medications that have provided little or no relief. It has been most studied in people with treatment-resistant depression and acute suicidality. It can also help patients with conditions such as PTSD, obsessive-compulsive disorder, bipolar depression, anxiety, and eating disorders. People with certain conditions, such as psychosis, are generally not candidates for therapeutic ketamine.
A study of ketamine users at three Virginia clinics published Monday in the Journal of Clinical Psychiatry found a significant reduction in depression. The evaluation of more than 400 patients at three Mind Peace ketamine clinics in Virginia found that mood improved in 72 percent of patients and 38 percent were symptom-free after 10 infusions. The study, conducted by the ketamine clinics on a self-selected group of patients, has its limitations.
Ketamine was approved as an anesthetic in 1970, but its use for treating psychiatric disorders is considered “off-label,” meaning it may be prescribed by a physician but is not approved by the Food and Drug Administration for that specific indication.
The one exception is ketamine, a nasal spray approved by the FDA in 2019 and marketed under the name Spravato for the treatment of treatment-resistant depression and acute suicide risk.
Biggest advance for depression in years: FDA approves new treatment for most severe cases
Gerard Sanacora, professor of psychiatry at Yale School of Medicine, said that while ketamine can be “life-saving” for some patients, many questions remain about the range of disorders it could help, the best route of administration, optimal dosing, and long-term safety. “It’s not a miracle drug for everyone,” he said.
What evidence is there for the usefulness of ketamine therapy
Considerable studies show that ketamine is a fast-acting antidepressant that ameliorates manifestation in many patients within a few hours or days. While no long-term data are public, in initial small studies, ketamine therapy resulted in significant and rapid relief of depressive symptoms in about 50 to 70 percent of patients. With conventional antidepressants, it can take four to six weeks to take effect, and some patients do not respond at all.
While traditional antidepressants can affect the levels of certain chemicals in the braining that are related to mood and emotion, ketamine affects a different neurotransmitter called glutamate. Ketamine can initiate a cascade of biochemical, structural, and functional changes in the brain. Essentially, ketamine is thought to make the brain more shareable and open-minded to therapies or alternative ways of reflection.
Other psychedelic drugs such as psilocybin, the active ingredient in magic mushrooms and LSD, and MDMA, known as ecstasy, are being researched to treat various mental illnesses, but esketamine and ketamine are currently the only drugs of this type that can be legally prescribed outside of clinical trials.
is Ketamine Safe?
Most physicians consider therapeutic ketamine to be generally safe with supervision and careful evaluation of patients, with the caveat that all drugs carry certain risks. They point out that ketamine is still a controlled substance, regulated by the Drug Enforcement Administration and subject to strict safety controls due to its potential for abuse. Certain medications and medical conditions make ketamine therapy too risky for some patients, doctors say.
Therefore, a complete psychological and medical history is crucial before starting any such treatment. The American Society of Ketamine Physicians, Psychotherapists & Practitioners recommends avoiding driving, working, caring for young children, or engaging in stressful tasks for the rest of the day after treatment group of mood disorders experts published last year in the American Journal of Psychiatry a summary of the current evidence on esketamine and intravenous ketamine for the treatment of treatment-resistant depression.
They noted that the drugs offer patients “opportunity and hope,” but that “there is an urgent need to clarify the long-term effects of these agents and that there are significant unanswered questions regarding safety.” Sign up for the Well+Being newsletter, your source for expert advice and simple tips to help you live well every day
How to Get a Ketamine without Prescription?
Find a doctor you trust or a mental health provider, and talk to them about the risks and benefits of therapeutic ketamine. ASKP3, the Society of Ketamine Physicians, estimates that there are approximately 600 providers in the United States who offer ketamine to treat thousands of people with a variety of mental illnesses.
Rakesh Jain, a psychiatrist in Austin, said that over the past few years, ketamine therapy has become very common among both psychiatric and non-psychiatric professionals.” The benefit is that “thousands of previously mistreated patients are finding relief.” But the number of providers is so large and growing so rapidly that there is simply no way to quantify how many clinicians are using therapeutic ketamine in their offices.”
Can Ketamine Self-Medicate?
A person considering ketamine treatment achieves the best results when they take the time to discuss the various options with a trusted provider or clinician, according to Raquel Bennett, a Berkeley-based psychologist and founder of KRIYA – Institute for Ketamine Research. Experts strongly advise against self-medication with ketamine because it can cause physical and psychological side effects, and patients who are left unmonitored can develop dependence over time.
Psychologically, ketamine can trigger a recurrence of traumatic events, and doctors note that monitoring is important when patients need support or guidance.
If ketamine works, why isn’t it used by all people with depression?
Ketamine’s potential to treat certain mental illnesses is gaining credibility with many physicians. However, ketamine is a widely available generic drug, and there is no incentive for a drug company to fund a large, high-quality study. Ketamine’s reputation as a recreational drug, the fact that it remains a controlled substance, and the lack of long-term data make some doctors and patients suspicious. Nothing seemed to treat her depression.
Then they tried ketamine. Are Ketamine Cycles Legal?
Is home ketamine therapy an option?
Physicians can legally prescribe ketamine for mental illness, but at this time there are no widely accepted oversight requirements or guidelines for patients.
As a result, ketamine vendors of all stripes have proliferated, from high-end spas courting their customers with zero-gravity armchairs and relaxation moon pods to ketamine mail-order subscriptions that include “healing playlists” Albert Garcia-Romeu, associate professor at Johns Hopkins College School of Medicine who researches psilocybin and other psychedelic drugs for mental health describes the landscape of ketamine therapy as “kind of like the Wild West” “You’re paying out of pocket, there’s no real standard protocol, the various Vendors take different approaches,” he said. “Some use it in conjunction with talk therapy, some don’t – they just put you in a bed, administer the treatment, and then you go home.
Numerous telemedicine companies – including Peak, Nue.life and My Ketamine Home – offer ketamine treatments directly Mindbloom, a telemedicine company founded in 2018, is offering patients in 30 states at-home ketamine therapy with virtual assistance, says CEO Dylan Beynon, instructing consumers to place the ketamine pill under their tongue for seven minutes without swallowing them, and then spitting them out while a “peer treatment monitor” — an appointed adult supervised by a Mindbloom “guide” — stands by.
Some providers are concerned about the lack of face-to-face supervision by clinicians. “There’s clearly a need for more supervision,” said Robert Meisner, medical director of the Ketamine Service in the Department of Psychiatric Neurotherapy at McLean Hospital at Harvard.
How much does ketamine therapy cost? Is it covered by insurance?
Back to menu
On average, a single ketamine infusion costs about $450 to $500, according to Sandhya Prashad, medical director at Houston Ketamine Therapeutics and president of ASKP3, the Society of Ketamine Physicians.
Six ketamine infusions over a two- to three-week period in a psychiatrist’s office, including a detailed pretreatment consultation and posttreatment follow-up, can cost up to $4,500. Companies that use ketamine at home typically offer the therapy at a lower price: Mindbloom, for example, charges $1,158 for a six-session treatment plan with virtual support; six follow-up visits cost $768. While some people achieve remission after just one round of treatment, others need monthly boosters.
Ketamine is “a treatment, not a cure,” Prashad said. “It’s very likely that ongoing treatment will be required
Generally, insurance will cover Spravato to treat mental illness, but not other forms of ketamine. However, there are some exceptions. Blue Cross Blue Shield of Massachusetts covers ketamine but requires prior authorization and strict criteria for use. In some cases, providers say, insurers that don’t reimburse for ketamine treatment may cover some of the associated benefits, so it’s worth checking the details of each plan.
Meryl Kornfield contributed to this article.