Ketamine for depression: growing list of medical centers offer infusions

A ketamine clinic in San
Francisco, CA
Erin Brodwin / Business
Insider

• Once dismissed as a “party drug,”
  ketamine is emerging as a potential alternative treatment
  for depression.
• A growing list of academic medical centers now offer the
  drug, including Columbia University, which
  began offering ketamine to patients with severe depression
  this fall.
• Ketamine
  works differently from common antidepressants like Celexa
  or Prozac and has been called “the most important discovery in
  half a century.”
• Pharmaceutical companies including Allergan and Johnson &
  Johnson are also working on developing blockbuster
  antidepressants inspired by ketamine.

Ketamine, a drug once associated with raucous parties, bright
lights, and loud music, is increasingly being embraced as an
alternative depression treatment for the millions of patients who
don’t get better after trying traditional medications.

The latest provider of the treatment is Columbia University, one
of the nation’s largest academic medical centers.

Starting this month, Columbia
joined a growing list of major medical centers offering

ketamine infusions to patients with severe depression for
whom traditional antidepressants like Prozac or Celexa have
failed. 

Elsewhere in the US, patients can get ketamine at a smattering of

private clinics, but not all of them
are subject to the strict medical oversight that’s generally
required of academic medical centers. In some cases, patients can
also get the treatment by participating in research studies, but
Columbia’s move helps make the treatment more broadly available.

Ketamine is not cheap, nor is it quick to administer. Because
it’s given by way of an
IV drip, the process can take between 45 minutes and two
hours. Each session costs $500 to $750 (Columbia is charging
$650) and is not covered by insurance, because ketamine is only
approved in the US for use as an anesthetic. 

Patients given ketamine for depression are typically advised to
get 8-12 sessions, bringing the total cost to as much as
$9,000. 

Despite its hefty price, ketamine has been called “the most
important discovery in half a century” for mental
illness.  The drug appears to
engage a different part of the brain than traditional
antidepressants, and its apparent rapid-fire effects may be
especially useful for staunching suicidal thinking in people who
are considering taking their own lives, experts say. Ketamine
also has a long history of being used to prevent pain, which
suggests to clinicians that it’s relatively safe.

“Ketamine is the real deal in that it’s a genuine pharmacologic
agent that’s been used for a long time for anesthesia,”
Jeffrey Lieberman, the chair of the psychiatry department at
Columbia University’s Irving Medical Center and the director of
the New York State Psychiatric Institute, told Business Insider.

And while ketamine’s applications for mental illness are
relatively recent, Lieberman is hopeful that the drug will
eventually be more widely available to patients in need.

‘The most important discovery in half a century’?

Cozine/Shutterstock

Most existing antidepressants, from Abilify to Zoloft, work by
plugging up the places where our brain takes up serotonin, a
chemical messenger that plays a key role in mood. The result is
more free-floating serotonin and, in some people, relief from a
dark curtain of depressive symptoms. But as many as
one in three patients fail to respond to the medications, and
no new depression drug has been invented since then.

Those are the patients who experts say
ketamine might help.

In those patients, it can be helpful to think of depression as
akin to severe pain, Cristina
Cusin, a psychiatrist at Massachusetts General Hospital
and an assistant professor at Harvard University, told
Business Insider this spring. When the pain gets so intense that
it gets in the way of everyday activities — even something as
simple as writing an email — patients can feel desperate enough
to do anything to alleviate the suffering. But current
antidepressants take 4-6 weeks to work.

That’s not good enough for patients who need help now, said
Cusin.

Read more:

A handful of clinics is embracing a ‘party drug’ that could be a
rapid-fire depression treatment — we got a look inside

A growing list of providers offering ketamine

Large institutions are starting to embrace ketamine therapy.

On the West Coast, the University of California in San Diego

began offering the infusions to select patients with severe
depression in 2010. Kaiser Permanente
started administering ketamine as part of a pilot program in
Northern California for people who didn’t respond to other
medications in 2015.

On the opposite side of the country, a handful of specialty
centers recently began offering the treatments. They include
Emory, Yale, and Massachusetts General Hospital, which began
offering the treatments this fall.

Several other medical centers including the Cleveland Clinic, the
Mayo Clinic, and the
Icahn School of Medicine at Mount Sinai are administering the
drug as part of ongoing research on ketamine and depression.

“The rapid antidepressant effects of ketamine in patients with
severe, chronic, and treatment-resistant forms of this illness
may represent a true medical breakthrough,” James Murrough, the
director of the mood and anxiety disorders program and an
associate professor of psychiatry and neuroscience at the Icahn
School of Medicine, wrote in an
October story for Scientific American.

Columbia University’s program is one of the first to not require
patients to show a specific number of failed treatments for
depression in the past. (At Kaiser, patients must show that
they’ve tried at least three different antidepressants and failed
to respond to each one.)

Still, Lieberman stressed to Business Insider that experts
carefully weigh the benefits and risks before recommending the
treatment to a patient, and they always advise people to try
traditional medications first.

“We have to do a very careful history and if [someone has] a mood
disorder, what’s their treatment been? Is the person genuinely
unresponsive to standard treatments?” Lieberman said.

How ketamine works

Ketamine is believed to engage a different brain system than the
one targeted by traditional antidepressants. It appears to act on
key switches in the brain called NMDA receptors, which influence
mood and help keep our brain’s synapses — the delicate branches
that serve as the ecosystem for our thoughts — flexible and
resilient.

Depression damages these brain switches. And while traditional
drugs may help to rescue them over time using serotonin, ketamine
appears to deliver its aid directly to the source, plugging up
NMDA receptors like a cork in a bottle and nipping depressive
symptoms quickly.

A spate of recent research supports this idea of how ketamine
provides relief.

Last December, researchers working with depressed and suicidal
patients concluded in a
study that ketamine was better at curbing suicidal thoughts
than a commonly-used sedative. Most participants
in the study, published in the American Journal of
Psychiatry, said their moods began to lift within 24 hours of
receiving the drug. In some people, those effects lasted more
than a month.

Similarly, the authors of a 2012
review of four preliminary studies on ketamine in patients
with severe depression expressed surprise at how rapidly the drug
appeared to produce positive and precise results.

Read more:

Pharma giants are looking to ketamine for clues to the next
blockbuster depression drug — and science says they’re onto
something big

But ketamine also has several drawbacks, aside from its steep
price tag.

Ketamine induces what many people refer to as a high. This
includes feelings of being dissociated from one’s body, floating,
as well as seeing bright colors and shapes. Some experts have
suggested this could lead to issues with
addiction.

In addition, ketamine’s side effects can include blurred vision,
headaches, and increased heart rate. And clinicians aren’t yet
sure how long ketamine’s anti-depressive effects last. While some
patients appear to experience a complete alleviation of their
symptoms after several weeks of treatment, others either fail to
respond or only see improvement for several days or weeks.

Nevertheless, several clinics outside of established medical
centers are also offering the treatments, and while some are
legitimate, others are what Lieberman described as “scary” and
“aggressive” in their marketing tactics.

“It’s not that ketamine shouldn’t be available — it absolutely
should — it just has to be available in a legitimate and
medically-controlled and rigorous setting,” Lieberman said.

Ketamine is inspiring several attempts to create the next
blockbuster depression drug

Ketamine is also inspiring research into other new depression
drugs that work on the brain in a similar way. Homing in on this
channel appears to provide relief from depression that is better,
arrives faster, and works in more people than existing drugs.

Allergan, the multinational pharmaceutical giant known for Botox
and birth control, recently dove deep into research on an
injectable depression drug called Rapastinel, which
works on the same brain pathway as ketamine. San
Francisco-based drug company VistaGen is
working on a similar drug known for now only as AV-101.

Similarly, Johnson & Johnson submitted a
nasal spray formulation of ketamine called esketamine to the
FDA in September for its review. New York-based biotech company
Seelos Therapeutics also has a nasal form of ketamine in its
pipeline called SLS-002.

But research is still early, experts say.

“We are just scratching the surface of the mechanisms of action
with ketamine,” Cusin said this spring.