Ketamine is inching its on its way to becoming a mainstream mental health therapy, and a host of new research suggests it has real potential for treating conditions like depression.
For example, a study published in September in the Journal of Clinical Psychiatry suggests that the anesthetic significantly reduced symptoms of depression, anxiety, and suicidal ideation in a cohort of 424 patients who attended ketamine clinics in Virginia. Because the study didn’t include a control group or systematically assess side effects, it has its limitations, but experts still say the results reinforce why so many researchers are excited about ketamine’s potential.
Meanwhile, a separate study also published in September, this time in the american Journal Of Psychiatry, found that the antidepressant effects of ketamine can be increased when people taking it are also shown positive words and images. This may be because ketamine appears to open a “window of plasticity” in the brain that helps forge new connections. This result could point to a potential method of extending ketamine’s benefits: ketamine’s effect can wane a few weeks after use, and infusions can be expensive.
As articles like these add to the ketamine research pile, and as the need for effective and accessible mental health treatments becomes increasingly obvious, it’s worth reviewing what ketamine is, what it can do, and what it can do. the role it may play in the future of medicine.
What is ketamine?
Ketamine is an FDA-approved anesthetic. It was developed in 1964 as a replacement for phencyclidine, a hallucinogenic drug once used as an anesthetic and now more infamous for its nickname, PCP, and the dangers associated with it.
Research interest in the use of ketamine to treat psychiatric conditions arose in the 1970s with the first formal investigation of the drug beginning in the 1990s. Ketamine was first found to have a rapid antidepressant effect in a double-blind randomized trial in 2000.
Ketamine is an N-methyl-D-aspartate receptor antagonist, meaning that it reduces the activity of these receptors. This inhibition is thought to explain why it works as an anesthetic, but over the years, scientists have discovered that ketamine causes a wide range of different molecular effects. Research suggests that ketamine can boost neuron growth while increasing glutamate levels in the brain. This effect is why ketamine can put one in a dissociative state; it is also the reason why it is used in medicine Y popular as a party drug.
Is ketamine legal?
It’s complicated. It is FDA-approved as an anesthetic, but the FDA does not recognize ketamine as a mental health treatment. The Drug Enforcement Agency classifies ketamine as a Schedule III narcotic.
In 2019, the FDA approved esketamine for treatment-resistant depression. Esketamine is derived from part of the ketamine molecule; it is more potent, so it can be used at a lower dose. Esketamine is administered through a nasal spray in a clinic; Because it can distort your perception, all of this should happen under the supervision of a doctor.
But ketamine is sometimes prescribed to some people for “off-label” use, meaning it is legal for a licensed physician to prescribe ketamine for a use that is not approved by the FDA. In these cases, ketamine is usually given by intravenous infusion.
In describing off-label use, the FDA notes that: “If you and your health care provider decide to use an approved drug for an off-label use to treat your disease or medical condition, remember that the FDA has not determined that the drug is safe and effective for the off-label use.”
This loophole is what has allowed for the recent proliferation of ketamine “wellness centers” and startups selling ketamine tablets. But some experts warn that in many cases this application of ketamine is not comparable to what is observed in studies. In turn, there are often no licensed medical professionals to supervise the administration of ketamine in these situations, and the use of the drug is not usually associated with psychotherapy or other intervention.
How can ketamine help mental health?
While some ketamine clinics advertise ketamine as a single solution for multiple mental health conditions, the science is more limited.
The research is strongest when it comes to treatment-resistant depression. This is when a person diagnosed with major depressive disorder does not respond to antidepressants after at least six weeks of use. It can be a life-threatening condition and is experienced by an estimated one-third of patients with depression.
Studies have also found that ketamine can reduce the severity of depression in people with suicidal ideation, making them less likely to harm themselves.
Research also suggests that it quickly confers these benefits and is safe in the short term. Because the therapeutic delay associated with other antidepressants can put patient safety at risk, ketamine’s fast-acting nature is a large part of its appeal.
Scientists are hopeful that further studies will verify its use as a multipurpose therapeutic treatment and that it may eventually be used to quickly help people who come to the hospital for psychiatric help.