Ketamine therapy is going mainstream as a treatment for depression, but how safe is it?
The effects of ketamine only last for 10 days, so after the initial course of IV infusions, you may be prescribed ketamine tablets to take at home once a week to maintain the benefits.
Unlike conventional antidepressants, which work by boosting the activity of particular brain chemicals such as serotonin, ketamine appears to impact glutamate, a neurotransmitter thought to play a role in regulating mood.
“Ketamine puts the brakes on, and often ideas about suicide and death seem to melt away,” Dr Rupert McShane, a consultant psychiatrist and associate professor at Oxford University, who has led a ketamine trial in the city, tells GLAMOUR. “At its simplest, ketamine helps to rebuild and strengthen connections. However, like conventional antidepressants, most people who are seriously unwell need to keep taking it for years.”
Just how safe is ketamine therapy?
Ketamine therapy has undergone clinical trials on both sides of the Atlantic. In 2006, the U.S National Institute of Mental Health concluded that a single intravenous dose of ketamine had rapid antidepressant effects. In the UK, doctors did a small study trialling ketamine to treat depression between 2009 and 2014. “Since then we have provided a clinical service to about 400 patients some of whom have continued to take it for 10 years,” says Dr McShane. “About half think it is worth continuing to pay for it.”
However, he called for a new system for monitoring ketamine and other psychedelics. “I think this is possible but it will require cooperation and agreement across lots of different organisations,” says Dr McShane. He adds that there is a minimal risk of dependency. “Ketamine is probably about as addictive as vodka,” Dr McShane says. “It all depends how much and how often you take it. Some patients need to increase the dose they take to get the same effect so this is why it needs medical supervision.”
And ‘medical supervision’ is key. Yet, worryingly, there is already a loophole in the US that some people are exploiting: home delivery of ketamine lozenges. Online platforms such as Mindbloom, My Ketamine Home and TrippSitter put clients in touch with psychiatric clinicians certified to prescribe drugs; they then self-administer the drugs at home.
While the research on low-dose ketamine treatment for mood and anxiety disorders is promising, it is, crucially, still in its early stages. For this reason, Dr Fritz Swart, a specialist in neuro-rehabilitation in South Africa, who has experience in addiction medicine and treatment of all types of mental health disorders, is more cautious.
“Ketamine is generally reserved for treatment-resistant depression (TRD) – in other words, depression that doesn’t respond to an adequate period of using antidepressant medication,” says Dr Swart. “The studies that have been done are relatively small and not robust enough to conclude that this treatment is safe. There are gaps in our knowledge of this drug and uncertainty remains about optimal dosing and duration of treatment.”
Specifically, Dr Swart raises alarm bells over the risk of addiction, especially with repeated courses of treatment. “The risk of serious adverse effects, mainly psychosis, which can also lead to suicidal, agitated and aggressive behaviour, is significant,” he notes. “It is therefore contra-indicated in people suffering from mental disorders such as Schizophrenia and severe mood disorders, such as depression or mania with secondary psychosis.”
Liekwise, the Oxford Health NHS Trust notes on its website that “occasionally people experience a worsening in their depressive symptoms and suicidality, which persists for up to two weeks after taking ketamine.”
So, while there is a trend for ketamine therapy to be offered in various practices and clinics, “I personally would not consider this, until more research is done,” says Dr Swart.
So, is ketamine therapy likely to become the next big thing in mental health and more widely accessible? Possibly, but until there is more extensive research and those gaps in knowledge are filled, its future, for now, remains unclear.