Why Doesn’t My Doctor Provide Ketamine as Treatment for Depression?
Studies are piling up that demonstrate ketamine’s remarkable effectiveness. It’s making people who suffer better. Not just “feel” better, but physiologically better.
You know… it’s really amazing when your brain is repaired and functioning well, how many aspects of your health and well-being improve. When you feel better and your outlook improves, you begin to see other aspects of well-being bloom.
Things like initiative, motivation, resilience. We know it’s true that depression compromises the immune system. And we also know a healthy, balanced outlook strengthens it. You feel like eating healthier. You don’t get sick as often, and can be more physically active. Which in turn improves cardiovascular and respiratory function. And that activity improves stamina.
Depression and anxiety sap stamina. Remission restores it.
At this point, the drug therapy winning the most kudos for reversing depression and anxiety that isn’t helped by traditional antidepressants is ketamine treatment. In my practice, we see a consistent response of 80% among those who’ve tried other medications without relief.
Ketamine is not specifically FDA-approved for the treatment of depression or other psychiatric disorders. And because it’s no longer brand name, it’s unlikely that any drug company will spend the colossal money required to gain FDA approval. But here’s the thing.
And it’s safe.
Ketamine has been used safely in adults and for children for more than fifty years.
In fact, it holds a solid position on the international list of drugs needed by the Red Cross for emergencies and disasters around the world.
Off-Label Use of FDA-Approved Drugs Can Provide Solutions
When doctors prescribe a drug for an “off-label” use, they do it prudently and inform themselves in advance about the drug’s benefits for this off-label purpose.
Neurontin, for example, was FDA-approved for epilepsy, but was found remarkably effective off-label for nerve pain and then got approved for it. It’s also effective off-label for anxiety and in alcohol detox.
Prazosin is FDA-approved for high blood pressure, but is often prescribed off-label to treat nightmares that accompany PTSD.
Propranolol is FDA-approved for treatment of high blood pressure and angina pectoris, or chest pain. However, it’s been found very effective off-label in treating performance anxiety. So a student whose mind freezes in a testing situation can be calm and perform on a test with mental clarity after a single dose.
Cymbalta is FDA-approved for depression but doctors found it to be so effective for fibromyalgia in their depressed patients while Lilly still had it under patent that Lilly got it approved for fibromyalgia. And then spread the word.
So you can see that prescribing off-label is not only medically acceptable — and common — but can lead to safe and effective breakthroughs.
For ketamine, which is FDA-approved as an anesthetic, studies by neuroscientists have demonstrated it is effective for relieving depression by at least four different actions across the brain. And clinical results have underscored the same.
Thousands of patients around the US have been treated with ketamine for psychiatric mood disorders at a 75-80% response rate.
Well with all this … why doesn’t my doctor provide ketamine treatment for depression, you ask?
Well, the answer is multi-faceted.
Any Emerging New Treatment Requires In-depth Study
For one thing, doctors don’t prescribe something they haven’t investigated. There are more than 1200 scientific papers about ketamine to digest and evaluate. With their very busy schedules, how do physicians access all that information efficiently?
There’s a plethora of scientific articles that range from basic science to clinical studies and that describe ketamine’s actions. And then there are the peer-reviewed studies, metanalyses, and opinion papers throughout the world literature on ketamine use in psychiatry that summarize current findings. Thousands of papers, tens of thousands of pages, and neuroscientists all over the globe are studying it.
But there is no drug company promoting it. There are no glossy brochures. Or drug reps with samples and sound-bites. Not even slick TV ads to make you clamor and ask your doctor for it. No easy ad campaigns. Nothing like that.
You need nights and weekends. LOTS of nights and weekends. Tons of hours. Academic privileges to access the journal articles or the willingness to purchase them one by one. All this extensive information isn’t prepared in a format that’s easily absorbed. The whole process can be daunting.
Complete Paradigm Shift for Psychiatrists to Offer a “Procedure” in the Office
Most psychiatrists haven’t done a procedure since residency. So it’s a horse of a different color to think about “treatment” as involving procedures other than the clinical work of talking, evaluating, providing psychotherapy, and writing a prescription for medication.
Many still consider ketamine an “experimental” drug. They don’t feel ready to invest the necessary time, money, space, staff and other adjustments required to offer a treatment and a procedure that requires thinking outside the box. Again, they need access to extensive information to move past their doubts and make those adjustments. But … an easily assimilated form of that information isn’t being generated for them.
Add to that the state and federal regulations regarding obtaining, storing, and administering controlled substances and OSHA regulations regarding safety and hazardous waste. What psychiatrist has ever had to deal with hazardous waste…?
It’s like starting a practice within a practice, with each side having its own requirements, staff, problems, demands, equipment, furnishings, regulations, reports, oversight, and on and on. It’s a gargantuan undertaking.
Caution About Trying a New Drug
In addition, there’s the issue of off-label use. Most doctors use some drugs off – label. But each time they make a decision to do that, they want to be assured of safety.
Ketamine requires space — for storage and equipment — and room for patients and the people they bring with them to drive them home — and special equipment for safe handling and safety monitoring. Most psychiatrists don’t know where to get it, how to start, how to monitor patients appropriately and safely and for how long. There is no manual or how-to book. Many don’t have the staff. Some don’t even have an answering service or a receptionist.
Beyond that, and despite the growing body of evidence, some doctors just feel cautious. They’re reluctant to try something new before all the potential obstacles have been removed and the effectiveness and safety statistics are well-established.
This is why a task force made up of some of the best and the brightest minds in neuroscience and psychiatry issued a consensus statement regarding the off-label use of ketamine for depression. Led by Gerard Sanacora, M.D. for the American Psychiatric Association, they published their experience about its use and its remarkable results,. And issued suggestions for appropriate screening, monitoring, and safety.
IV Ketamine Treatment Is Costly
Why is that? Because ketamine itself is kind of cheap.
But psychiatrists who do offer IV ketamine treatment take on responsibility and big expenses to provide it safely. Since the preferred route of administration at this point is intravenous infusion, or IV, extra safeguards have to be put in place.
Things like space, equipment, regulations for handling, storing and disposing of controlled substances are required. Add to that the extensive policies and procedures for all of this. Plus new staff, DEA compliance, hazardous waste disposal, nursing staff salaries, equipment for continuous monitoring of vital signs.
Think about this. Many psychiatrists don’t even have an answering service. Or office staff.
SO … what drives us, the ones who take it all on?
Ketamine treatment is saving lives.
Doctors Make Up Their Own Minds About Ketamine – In Their Own Time
Of course we do. Some are willing to reach out and try something they haven’t tried before, to find solutions for their patients who suffer. Others worry about the data, and the risks of lawsuit for potential reactions to a drug they don’t fully understand. Still others prefer to wait until more drugs are developed that mimic the action of ketamine, and that can be FDA approved on their own merit.
Meanwhile, the cost for that caution? Unnecessary loss of life. Ketamine demonstrates its ability to not only provide relief for psychiatric mood disorders, but also its tandem and separate action to rapidly erase suicidal thinking that saves lives in emergency situations in clinics and doctor offices around the world.
While traditional antidepressants reduce suicidal thinking within 9-12 weeks, many patients at risk of suicide can’t wait that long. Ketamine acts to erase those thoughts within 4 hours…and many times in only 45 minutes.
Dr. Stephen Hyde, an Australian psychiatrist, says that once those new drugs are developed and approved by the FDA – a many-years-long process – there will still be no data about long term side effects until 20 or 30 more years have passed. Sooo….how many lives will be lost in the meantime? Ketamine is available now.
His suggestion: Why not use it now for those who won’t live that long without effective treatment, and compile data now about long term use?
Some of us believe that’s the best choice.
Sanacora, the lead in the APA consensus statement, expressed it this way. In an interview with NPR news that followed the publishing of the task force consensus statement he said:
“If you have patients that are likely to seriously injure themselves or kill themselves within a short period of time, and they’ve tried the standard treatments, how do you not offer this treatment?”
We offer Ketamine as Treatment for Depression, When It’s a Good Match for You
I hope that more and more psychiatrists learn about ketamine, and choose to stretch their capabilities even farther than they have. That in following the guidelines of the APA task force, they’ll help more people achieve rewarding lives through ketamine treatment.
In the meantime, in my practice, I offer everything I possibly can that can safely bring relief to patients whose lives are passing in misery…or torment…or are about to end in suicide.
At Innovative Psychiatry, 80% of our patients respond well who’ve been failed by traditional treatments. And for the other 20% we continue to pursue solutions, and apply a combination of treatments to bring them relief. We never stop. We live to see you well.
If you suffer from psychiatric mood disorders such as major depression, anxiety disorders, PTSD, OCD, bipolar depression, or a similar illness, and traditional antidepressants have failed you, call us. Schedule an appointment to determine if ketamine treatment is right for you.
We look for genetic markers and other signs that indicate if you’re likely to respond and benefit from ketamine, and determine the best treatment plan for you.
Ketamine treatment is not for everyone, but it could be just right for your recovery, renewal, and restoration.
To the emerging of your best self,
Lori Calabrese, M.D.