Ketamine, notorious club drug, shows great promise as a treatment for depression, clinic operators say
Despite years of therapy and a trove of medications, Misra, 36, had become so despondent that she started planning her suicide. But before she acted, her psychiatrist introduced her to a new treatment with an unusual back story.
The treatment was ketamine, an anesthetic used to sedate both people and animals before surgery. It's also a notorious street drug, abused by clubgoers seeking a trancelike, hallucinatory high.
But in recent years, numerous studies have found that ketamine can be an effective and speedy treatment for people with depression -- particularly those who, like Misra, have found little relief from traditional medications.
"After the first couple of treatments it didn't seem to work, but after I hit my fourth one, everything started to change," said Misra, a therapist and college instructor who lives in
Though some researchers have found that ketamine can be a valuable antidepressant, no one has performed the large-scale clinical trials necessary to get
Consequently, most insurance plans won't pay for it, leaving patients to fork over thousands of dollars out of pocket for a series of intravenous infusions.
Some warn that questions remain about ketamine's long-term safety and effectiveness. Dr.
And because ketamine has a history of abuse, he said, doctors and patients must consider the threat of addiction.
"We think the risk is low, but it's probably not zero, particularly if it gets scaled up," he said. "There's excitement but also a justified caution."
Nonetheless, demand for the drug is so keen that dozens of specialty clinics are popping up around the country, including at least four in the
"It's much better than anything we've had before," said Dr.
Fast-acting drug
Ketamine was created as an anesthetic, and doctors from veterinarians to battlefield medics embraced it for its fast-acting properties and relative safety. But because it produces strong out-of-body sensations in high doses, it became a club drug, potent enough to send hundreds of people to emergency rooms each year.
In the 1990s, researchers discovered another use for ketamine: A small dose, they found, limits the concentration of a neurotransmitter called glutamate in the brain, and with startling speed, lifts the mood of many depression sufferers who haven't been helped by traditional medications like Prozac or Lexapro.
"Our standard antidepressants can take six to eight weeks to be effective -- ketamine can take just one hour," said Dr.
Over the last few years, doctors have opened specialty clinics that offer ketamine to patients who have depression or, to a lesser extent, chronic pain. Though the
The basic regimen calls for the intravenous infusion of a small dose -- 0.5 mg per kilogram of body weight, far less than someone would use to get high -- six times over two weeks. After that, patients return every few weeks or months for booster doses.
Clinic operators say they screen clients to focus on those who have failed to improve with standard antidepressants.
"This is a last resort for those that are treatment-resistant," said Dr.
Zarate said research has shown ketamine to be effective for about 60 percent of people with treatment-resistant depression, though some local clinics say their results have been better.
"We've had about a 70 percent response rate, but it really works for them," said Dr.
He charges
But for now, the out-of-pocket cost limits the number of people who can afford the treatment. Misra said that while she put the infusions on her credit card, seeing them as a life-or-death investment, others aren't so fortunate.
"I have patients who are struggling right now, and they actually can't swing it," she said. "I think that's a horrible thing. No one should have to die because they can't pay for treatment."
The research that has come out since then has persuaded him that it is appropriate for many people, he said, but he still believes doctors should voluntarily share data on their results to further knowledge of the drug and improve the protocols for using it.
"In a sense, each patient they treat is an experiment of one," he said. "It would be really helpful if all these clinics got together and figured out a way to report those outcomes. Without those data, I worry that someone's going to get hurt."
Ready to go
One recent morning, a 57-year-old woman settled into a recliner at IV Solution, a Near North clinic that specializes in ketamine. A nurse started an intravenous drip as Dr.
"You ready to go?" he asked.
"I'm ready to go," she answered.
"Let's do it."
The woman, an attorney who asked not to be named to protect her professional standing, said she had suffered from depression and anxiety since she was a teenager, and hadn't found much relief from standard medications or therapy.
"The best way I can describe it is like you're walking in heavy boots through the mud all the time," she said. "You can get where you're going, but you're constantly fatigued and it's a struggle."
After learning about ketamine through a TV report, she said, she came to Nandra's clinic for her first treatment in January. It took several sessions for her to notice a change, she said, and even then it was subtle: She didn't feel soaring happiness but simple normalcy.
She had returned to the clinic for a booster, her first treatment in a month. Nandra said some patients require boosters at regular intervals, while others see the time between infusions stretch ever longer as their brains adapt.
The woman said she wasn't concerned about that schedule. For the first time in a long time, she said, she is looking to the future with hope, not dread.
"If this gets me through this next patch, we don't know what's around the corner in terms of research," she said. "This might get me to the next thing that really solves the problem. But certainly the idea that I want to keep going is a pretty big solution to me right now."
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