From cat tranquilizer to party drug to novel antidepressant, ketamine has come a long way in the past 55 years. Originally developed as an affordable and effective anesthetic, it has recently become the latest line of defense for treatment-resistant depression, anxiety, PTSD, OCD and even nerve-related pain disorders like fibromyalgia or neuropathy. In most cases, the treatment is offered in the form of infusion supervised by clinical coordinators and/or medical doctors. Currently, the treatment is considered an off-label use, meaning that it hasn't been specifically approved by the FDA for these conditions but due to overall safety and effectiveness after multiple research studies and anecdotal evidence from ketamine clinic patients, the practice is slowly becoming more mainstream.
One interesting thing about ketamine-based treatment is the speedy onset of relief. Traditional SSRI (selective serotonin reuptake inhibitor) antidepressant drug effects are often not felt within the first month, if at all. With ketamine treatments, for those who respond, the effects are nearly immediate. Most patients are aware whether the ketamine infusions help within hours of the first infusion. At this point, a series of infusions is scheduled over a two-three week period. For most who have sought treatment, side effects are non-existent, which for antidepressant drugs is remarkable. Oral antidepressants generally come with some sort of negative peripheral effects ranging from loss of libido to suicidal ideations.
The Ketamine Treatment Center was founded in 2011 by Dr. Steven P. Levine, a psychiatrist. Levine pioneered the specific protocol to be used during ketamine infusion treatments and has overseen thousands of infusions himself as well as helping establish similar programs across the country. Dr. Levine and Dr. Anand Dugar, a board certified anesthesiologist, have partnered to help treat major depression, bipolar depression, post-partum depression, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), fibromyalgia and other pain related syndromes.
Steven Mandel at the Ketamine Clinics of Los Angeles, who has given more than 4,000 infusions over the past four years, spoke recently to Wired magazine.
"The other antidepressants take weeks to months to have an effect. Ketamine kicks in within hours," he says. "It works on people that nothing else has worked on."
According to the National Institutes of Health, up to a third of those suffering from depression don't respond to prescription antidepressants like selective serotonin reuptake inhibitors (SSRIs).
"I don't think anybody should be afraid of it," tech entrepreneur Spencer told Wired. "You're not getting handed pills at a club by somebody. You're going to a professional and you're in a space that's safe."
The jury is still out and more trials will have to be run before the treatments are approved specifically by the FDA, but Dr. Mandel told Wired that out of more than 600 patients, 83 percent have shown improvements. Ketamine treatments aren't offered for cases of mild to moderate depression. For now it is only used in only severe cases, specifically treatment-resistant clinical depression where typical SSRI's have failed to qualify. At the moment, ketamine, ECT (electro-convulsive shock), TMS (trans-magnetic stimulation) and ketamine therapy seem to be the most effective treatments for the hardest cases.
California, New York, Michigan, Idaho, Pennsylvania, South Carolina, Maryland, New Jersey, North Carolina, Minnesota, Illinois, Arizona, Ohio, Washington, Iowa, New Hampshire, Oregon, Texas, Indiana, Tennessee, Georgia, Alabama, Alaska, Florida, New Mexico and Virginia all have either ketamine clinics or physicians who will administer ketamine off-label. Ketamine is approved by the FDA currently for anesthesia but not for treatment of depression. As a result, many insurance carriers will deny covering it but for those who have not experienced any improvement with SSRI's and in some cases even ECT or TMS, ketamine can be a life saver. Sean Spencer, a young Silicon Valley entrepreneur, weighed in on the issue.
"I hope in the future that it's more accessible. I know people who have been on the brink of suicide and done it and it's 180 changed their lives."As with many psychoactive substances, the exact mechanisms are somewhat of a mystery, but it's theorized that regrowth of dendrites (ketamine induces spontaneous neurogenesis, the growth or regrowth of brain cells) may be a key. About two-thirds of those who are treated with ketamine infusions find the treatment relieves their symptoms. Last year the FDA moved to "fast track" the approval of the drug for clinical depression. If the drug is approved, it would be the first new treatment for clinical depression in nearly 50 years.
[Featured Image by Victoria Arocho/AP Images]