Ketamine is a hallucinogen that has been approved by the Food and Drug Administration as an anesthetic for decades. But it is also used illegally as a party drug. Over the last few years. Growing research has found that the drug also works for treatment-resistant depression in some people. Which led the FDA to approve a version called esketamine, or Spravato. In 2019. It’s an inhaled version that must be administered in a doctor’s office. And it is approved only for people for whom other treatments have failed.
But in recent years — even before the approval of Spravato — a new industry has emerged: ketamine clinics. Which offer the drug off-label as either. An infusion or an injection for a wide variety of mental health problems. “Off label” use means the drug. Hasn’t been specifically approved for those conditions.
At Field Trip, a national chain of clinics. That has offered ketamine-assisted psychotherapy for several mental. Health conditions since 2019. Patients first undergo a screening to see. If they qualify for treatment. If so, patients get shots of ketamine while they lounge wearing eye masks as clinicians lead them through guided meditation. They also meet with therapists before and after their “trips.”
“Patients say, ‘This changed my life,’” said Mike Dow, a psychotherapist at a Field Trip clinic in Los Angeles.
It’s unclear how ketamine works precisely in the brain. Dow said he believes it may boost feel-good chemicals, similar to traditional antidepressants. As well as reduce inflammation, and form new neural pathways that are associated with the ability to create new habits and behaviors.
People also undergo psychedelic experiences that can feel spiritual, which in itself can boost their mood, Dow said.
But as the number of new ketamine clinics skyrockets, with centers springing up across the country. Some doctors are worried that it’s an unregulated industry that’s ripe for danger.
Because the drug has FDA approval, any doctor can prescribe it off-label. Clinics aren’t regulated federally, but they are subject to the same state laws as other outpatient medical clinics.
“The concern with these clinics’ popping up is that people are getting treatments that haven’t been well-proven. Well-studied or following any guidelines. Said Dr. Smita Das. An associate professor at Stanford University School of Medicine. And chairwoman of the American Psychiatric Association’s Council on Addiction Psychiatry. “My concern is that people who need treatment will spend their money. And energy in these ketamine clinics that aren’t well-proven.”
Treatments can be expensive — from $400 to $800 a session, on average, said Kathryn Walker, the CEO of Revitalist. A chain of clinics that offers ketamine infusions — and they aren’t covered by insurance.
There can also be side effects, including changes in mood and blood pressure.As well as nausea and drowsiness.
Das and Dow say they’re also concerned that some clinics may be offering the drug without any supervision. Which is especially worrying if a patient has a “bad trip.”
Only a few small studies have looked at its benefits for other mental. Health conditions beyond treatment-resistant depression. And the American Psychiatric Association doesn’t provide specific guidelines for its use.
“People can rarely experience paranoia or suicidal ideation,” Das said. “And so many of these clinics don’t have mental health professionals staffing them. When those mental health concerns pop up, they may not be equipped to respond appropriately.”
Ketamine also isn’t a cure-all. Not everyone responds to treatment. And it can stop working in some people. Said Dr. Subhdeep Virk, the director of the Treatment-Resistant Depression Program at Ohio State University Wexner Medical Center.
“It’s very hard to predict who is going to respond and how long it’s going to last,” said Virk. Who has been treating patients with ketamine since 2018. She added that it’s also unclear whether the drug can. Help conditions besides treatment-resistant depression. .
Lynette Ebberts, 66, said that for her. Ketamine was a lifeline. For nearly 40 years. Hhe said, she tried dozens of combinations of antidepressants. Electroconvulsive therapy and other treatments for her severe depression. But nothing worked.