A new study shows how the powerful drug ketamine could help fight severe depression
Ketamine has an unsavory reputation. The medical anesthetic is used on humans and small animals for surgeries, but it’s also made into a recreational street drug called Special K with powerful dissociative effects. “An 18-hour holiday,” the punk band NOFX sang on 1997’s “Kids of the K-Hole.” “You start to lose track of where your body begins and ends,” wrote an enthusiast on Reddit’s /r/ketamine forum a year ago. “The stupidest drug ever invented,” Brian Moylan described for Gawker in 2012.
But a new study adds more information to the growing body of evidence that ketamine can also be used to combat severe depression and suicidal thoughts.
Scientists have shown ketamine’s efficacy in treating depression in multiple studies, and on Tuesday, another paper was published in the American Journal of Psychiatry, describing how ketamine “reduced suicidal thoughts, within one day and for up to one week in depressed patients with suicidal ideation.”
“We like to think of it as a hardware fix, rather than a software fix,” Dr. Glen Z. Brooks, the founder and New York medical director of NY Ketamine Infusions, said in a phone interview. His treatment center has performed more ketamine treatments on depressed patients than anywhere else in the world, he said. In the past five years, it has treated more than 1,500 people.
Brooks said most of his patients are people who experience severe PTSD and depression from childhood trauma. These patients haven’t seen improvement from more traditional psychiatric drugs and therapy, so they come to Brooks for ketamine infusions.
Ketamine “reduced suicidal thoughts, within one day and for up to one week in depressed patients with suicidal ideation.”
“For the last 50 years, psychiatrists have been treating symptoms of post-traumatic stress disorder as if it were a chemical imbalance. What the ketamine scientists have been saying for 20 years is it’s a structural problem,” Brooks said. “It’s something you can actually see under a microscope.”
“Ketamine treatment is a great idea,” Dr. Ragy R. Girgis, assistant professor of Psychiatry at Columbia University Medical Center, said in a phone call. He said that the study “seems like an accurate, good finding.”
Historically, ketamine has been used as an anesthetic
“My only experience with using the drug is giving anesthesia,” Dr. Brian Mulkerin, an anesthesiologist in Tucson, Arizona, said in a phone interview. (Mulkerin is the father of Mic reporter Tim Mulkerin.)
“I have used ketamine quite a few times in the past, but it’s not one of my mainstream anesthetics because it does have some issues and side effects,” like hallucinations, Mulkerin said. It can result in “dysphoric and unpleasant feelings” for people as they’re waking up from anesthesia.
Mulkerin is aware of ketamine’s success as a depression treatment and acknowledged its reputation as a “horse tranquilizer.” “It’s kind of a strange anesthetic,” he said. “They know a few things that it does, but it’s not clear what its mechanism of action is” — what it does in the human brain.
There are specific cases in which an anesthesiologist would give someone ketamine. “With a lot of our other anesthetics, when you give someone anesthesia, their respiratory drive will decrease and you have to take over their breathing,” Mulkerin said. “Their cardiovascular system will be affected and their blood pressure will go down. So if you have someone who you need to keep breathing spontaneously, or has unstable blood pressure, ketamine can be a good drug to use.”
What it’s like to undergo ketamine treatments
Professor Allan Young of the Royal College of Psychiatrists in the U.K. told the Guardian in June that ketamine is “one of the most exciting developments in mental health in recent years.” But ketamine is not without its detractors, and its treatments don’t work for everyone.
Dr. Brooks said he believes that ketamine infusions work best for people dealing with depression and/or PTSD specifically from childhood trauma. “The key to my patient selection is that I need to know that their mood disorder began during childhood,” Brooks said.
I reached out to comedian Neal Brennan, best known as the co-creator of Chappelle’s Show, who went on the Joe Rogan Experience podcast the week after he finished ketamine treatments for depression in June 2015. Brennan had been getting treated for severe depression for more than a decade before he had the infusions.
“I just started looking up other shit to do, and the big one that kept coming up that I saw was ketamine, so I was like, ‘That’s interesting,’” Brennan told Rogan. “I knew it was a party drug, but I didn’t really know that much about it.”
“The treatment is, you do six sessions in two weeks,” he said. “He hooks the IV up, and within 15 seconds I was gone. At first you just get sleepy, and then I was in the trip ... for 45 minutes. And then ... you slowly come out of it.”
“After I was done, I probably lay in the bed there for like an hour. ... I could barely stand.” — Neal Brennan
“When I came out of the first one it was rough,” Brennan said. “After I was done, I probably lay in the bed there for like an hour. ... I could barely stand.”
After two weeks of treatments, he said he felt “better every day.”
Now, though, two years later, he said he doesn’t believe it worked for him. “I don’t doubt that it works for some,” Brennan said in a direct message on Twitter. “It just didn’t work for me in particular. Can’t really shed any light as to why. Just doesn’t work for everyone.” He “just didn’t like it,” he said.
The future of ketamine as a depression treatment
This is just the beginning for ketamine. “Additional research on ketamine’s long-term safety and its efficacy in reducing suicide risk is needed before clinical implementation,” the study’s authors wrote.
Still, it’s starting to find more mainstream acceptance. “Ketamine is pretty safe,” said Columbia’s Dr. Girgis, who is also the director of the Center of Prevention and Evaluation. “We use it all the time.”
The next step for ketamine is for it to get FDA approval as a treatment for depression. “Ketamine is FDA-approved for other conditions, so it can be used off-label,” Girgis said. “It’s probably not covered by insurance.”
Eventually, Girgis said, “we want it to be approved for depression. ... As long as we give it to the right people.”