Doctors treating depression see promise in ketamine, a cheap drug already approved for anesthesia

July 21, 2021

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The anesthesia medication ketamine is showing increased promise as a treatment for people experiencing depression who haven’t found relief with other prescription medications.

Though ketamine is known for its recreational use as a party drug, it can also be prescribed legally by doctors. In recent years, ketamine has become more accessible for those struggling with depression. In 2015, there were fewer than 60 ketamine clinics in the U.S. Three years later, there were more than 300, according to the journal of Psychiatry and Clinical Neurosciences.

Generic ketamine isn’t specifically approved as a depression treatment, but U.S. doctors are often allowed to prescribe Food and Drug Administration-approved medicines “off-label” for another use.

A growing body of evidence has shown ketamine, which has been used since the 1970s in the field of anesthesia, can be successful in treating depression and suicidal behaviors. In fact, ketamine is part of a growing field of research into whether drugs that have traditionally been viewed as illegal psychedelics or party drugs could, in certain contexts, help people with depression, post-traumatic stress disorder and other behavioral health and psychiatric disorders.

In 2019, the FDA approved Spravato, a ketamine-related nasal spray drug, given in conjunction with antidepressants that has been shown to help people with treatment-resistant depression. But many clinics offer generic ketamine, often in the form of intravenous infusions.

Dr. Steven Mandel, founder and president of Ketamine Clinics Los Angeles, said because ketamine is already a low-cost generic drug, it’s unlikely that a pharmaceutical company would pay for the process that would be needed to get the drug approved specifically as a depression treatment.

“For a medicine like ketamine that is already approved and available, adding a new indication for the treatment of depression would probably cost tens of millions — if not hundreds of millions — of dollars,” Mandel said. “No one wants to spend that money.”

But ketamine’s unique status can create problems for patients. Ketamine’s use for depression is off-label and it is typically not covered by health insurances. Because of this, “there are some access issues,” said Dr. Panagiota Korenis, a psychiatrist and associate professor at the Albert Einstein College of Medicine.

“It’s often limited to a subset of the population that can pay out of pocket or be a part of a trial,” she said.

There are also certain risks associated with ketamine.

“It is a drug that can be abused potentially,” said Korenis, who noted that patients typically need to be treated in the clinic and typically cannot take multiple doses of the medication home with them.

Nevertheless, Korenis is hopeful that ketamine may prove itself as another powerful option for those with depression.

“Ketamine certainly is being shown to be a medication of interest and one that has potential for the future,” said Korenis.

Experts debate whether ketamine is a psychedelic and able to produce similar altered states of consciousness as MDMA and psilocybin, which have shown healing properties in some studies.

But many clinics are opting to administer ketamine in a manner similar to psychedelics in clinical trials. Ketamine-assisted psychotherapy, or KAP, is a combination of ketamine and therapy that is similar to psychedelic-assisted therapy used in recent carefully controlled clinical trials.

For example, MDMA, also known as molly or ecstasy, is a psychedelic drug that is now being studied in controlled therapy settings as a possible treatment for PTSD. But no psychedelic treatments are FDA-approved, meaning doctors cannot administer them outside of a clinical trial. MDMA is illegal for recreational use in the U.S.

For those who are unable to get into a clinical trial of psychedelics like MDMA and psilocybin, KAP may be the closest legal equivalent.

“Ketamine works for depression and suicidality — it works quickly, it’s safe,” said Mandel. “For the other medicines, we just don’t know. They seem to have great early promise, but we do need a lot more data and a lot more time before we can fully embrace them.”

Psychedelics like MDMA and psilocybin may require a couple of more years until they receive FDA approval, according to Rick Doblin, Executive Director of the Multidisciplinary Association for Psychedelic Studies. In the meantime, Mandel hopes more patients learn about ketamine as an option for depression.

“Ketamine should be available to anyone suffering from these afflictions,” said Mandel.

Nicholas Nissen, M.D., is an author, host of the “Brain Health with Dr. Nissen” podcast and a contributor for the ABC News Medical Unit.