Ketamine clinics have popped up all over country to administer the drug to patients suffering from major depression, bipolar disorder and post-traumatic stress disorder. What benefits can this clinical anesthetic turned street drug provide to those suffering from these conditions?
Most antidepressant drugs target the serotonin system in ways that increase availability of that precious neurotransmitter. Psychiatrists prescribe drugs that either block the breakdown or reuptake of serotonin. The current antidepressant medications work in many cases but not for everyone. Dr. Irving Kirsch and colleagues from Harvard Medical School rehashed old data from a 2008 study, and they found that many antidepressants didn’t have any significant effect compared to a placebo—though these results are still contested.
On the other hand, ketamine affects the brain in a completely different way than classical antidepressants, and researchers do not fully understand it. Many doctors have abandoned standard treatment procedures, starting special clinics that administer single, monitored doses of ketamine. These so-called “ketamine clinics” have popped up all over the country and sometimes sell single administrations of ketamine for up to $1000 per dose. Are these clinics taking advantage of patients in need, or do they really have their patients’ best interests in mind?
While the FDA has not approved the use of ketamine for depression, doctors are permitted to prescribe ketamine to treat any condition as long as they think it’s medically appropriate as an “off-label” use. In this case, ample research does exist to support the use of ketamine for both unipolar and bipolar depression. Due to the fact that treating depression with ketamine is an off-label use, the majority of health insurers will not insure any patient visits to a ketamine clinic.
The treatment programs that ketamine clinics provide hinge on ketamine’s major setback—the duration of efficacy. The anti-depressant and anti-suicidal effects begin as soon as the dissociative effects wear off, but normally only last for about three months. Depending on the patient and the clinic, physicians may prescribe initial repeat doses followed by more infrequent doses at regular intervals.
“Even though the average length of response for an individual is between five and seven days from the single infusion, it is interesting that even at four weeks, more than a third of the people who do respond are seeing a greater than 50 percent reduction in their symptoms,” said Dr. Cole J. Marta from Interventional Psychiatry Associates at the Psychedelic Awareness Salon in Los Angeles.
The appearance of ketamine clinics around the country highlights some of the existing problems in the pharmaceutical market. New, recently developed drugs have marketing and research staffs, who actively promote them to doctors and psychiatrists. Old, off-patent drugs collect dust. In the case of ketamine, new research has surfaced to support its use beyond that of a tranquilizer.
In the case of pharmaceuticals, the grass might not always be greener on the other side; drugs with expired patents may still be useful for a myriad of uninvestigated uses. These old drugs need further research to expand their FDA-approved uses, and physicians need the proper resources to identify the best drug and treatment program for each individual patient.