In life, that which is old seems to eventually become new again.
Ketamine is quite a remarkable molecule with an even more impressive story. It was synthetically designed in 1962 to solve the anesthetic problem of suppressing breathing rates from traditional anesthetic drugs used in surgery. It was deemed to be extremely safe, so safe that in Vietnam every soldier carried on them a ketamine injectable syringe (known as the buddy drug). The intent there was to administer the drug to anyone in the battlefield who suffered a severe injury so they could get immediate pain relief without breathing complications. It has gone on to become part of the World Health Organizations List of Essential Medicines. Ketamine’s overall safety cannot be overstated. This FDA approved drug is administered every day in emergency rooms around the world to children who suffer injuries, such as fractured bones, that require sedation and fixing of the injury.
Ketamine has spent a great deal of time out of the medical setting and has been on the recreational rave scene for many years. At lower dosages, lower than what we use in anesthesia, it was found to produce a trance like state and euphoria. At lower doses people report complete dissociation from normal thought patterns and describe a psychedelic experience. Psychedelic experiences can be mystical experiences that help transform individuals when used in the proper setting with the proper mindset. They can also be very unpleasant when taken without consideration or intent, or in an anxiety provoking environment. As the world looks to new therapies to help individual heal from trauma, anxiety or severe depression the psychedelic experience paired with psychotherapy looks extremely promising for producing long-lasting dramatic outcomes.
Its only as of late have we begun to discuss ketamine as an anti-depressant but its anti-depressant effects and its ability to help treat major depression at low dosages has been known for decades. Ketamine treatment and psychotherapy research dates all the way back to 1971. A study done in Mexico City showed that 85% of people with “neurotic” issues reported positive outcomes when using ketamine infusions and therapy (https://www.samorini.it/doc1/alt_aut/lr/roquet.pdf). In 1973 a study (which can be found on the United States’ National Institute of Mental Health website) of 100 people in Iran showed that 91% of patients who used ketamine “did very well” in terms of improving mental health symptoms when using a dose of ketamine and therapy together (https://www.ncbi.nlm.nih.gov/pubmed/4800188). The research began to diminish with respect to ketamine but was revitalized in the last decade as many search for new mediations to help patients struggling with debilitating mental health issues. In 2019 a large review of 235 patients using ketamine and psychotherapy demonstrated dramatic shifts in depression and anxiety for a host of mental health illnesses (https://www.tandfonline.com/doi/full/10.1080/02791072.2019.1587556). The medicine was also shown to be safe with minimal side effects. In 2016 we also produced a double-blinded, randomized, placebo-controlled clinical trial using ketamine intravenously. The results from this study showed ketamine worked rapidly (within one dose) compared to traditional anti-depressants that take six weeks. It also demonstrated that compared to placebo, for treatment resistant depression, ketamine was effective in reducing depression scores (https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2016.16010037).
Pharmaceutical companies have taken note of the healing powers of ketamine and Johnson and Johnson now have a nasal spray known as “Spravato”. The goal with this nasal spray is to take low dosages of ketamine that produce minimal side effects but also avoids the psychedelic experience. While this may sound appealing to many, the evidence is quite clear: if you want to generate dramatic changes in a person’s mental health, they require a dramatic experience (https://www.ncbi.nlm.nih.gov/pubmed/29501990). By avoiding the psychedelic experience, the evidence suggests we likely will not see dramatic changes in patients well-being long-term. An also unpleasant experience of Spravato is the cost, which can be $4,720-$6,785 for a one-month treatment (https://www.statnews.com/pharmalot/2019/03/22/antidepressants-cost-effective-johnson-and-johnson/). This seems expensive for a drug that is generic and used daily for over sixty years.
So is ketamine a new wonder drug? Can we really teach old drugs new tricks? The evidence to date is impressive. Combining ketamine with psychotherapy looks to be the gold standard today in depression treatment in producing the very best possible outcomes for people suffering with severe mental health illnesses not responding to traditional options. As the we continue to conduct research on ketamine and other psychedelic molecules we will witness the slow transformation of a system that is currently focused on a pill a day to suppress symptoms into a system that promotes mystical experiences to influence profound healing in individuals that bring about lifelong positive changes in mental well-being.