If you've heard of Ketamine, or "Special K," as it's often called on the street, you most likely think of it as an illicit party drug—one that creates such a dissociative high that it's often used as a date rape drug.
But the increasing use of Ketamine to treat medication-resistant depression is slowly changing that view. While Ketamine has been used to treat mental illness for several years, lately, that application is bringing the drug into a new spotlight, perhaps because of a social shift in the way drugs like cannabidiol (CBD) and psilocybin, which are also getting new attention for their non-illicit applications. In Boise alone, there are two clinics specifically dedicated to administering Ketamine for depression: the Boise Ketamine Institute and Boise Ketamine Clinic.
When the Boise Ketamine Clinic opened about three years ago, it was only one of roughly a dozen clinics in the nation; now there are more than 150 nation-wide.
"It's just exploded," said clinic Owner, operator, and Certified Registered Nurse Anesthetist Nykol Bailey. "Not only the nation but the medical and psych community is slowly changing the stigma surrounding the use of psychedelics."
Bailey got into the Ketamine business after losing someone to suicide in her early 20s, and started searching for ways to spare others the same kind of loss. Ketamine is typically used for starting and maintaining anesthesia, making anaesthesiologists the most qualified people to administer it.
Results from Ketamine use for depression have shown promise, with as much as a 50% reduction in symptoms of depression and anxiety within two weeks and success in about 70-80% of patients (the success rate of oral antidepressants is lower, at 50-60%).
But Ketamine is not for everyone. The drug is reserved for people who have already tried several medications and therapies, including electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS). Once patients have been approved for Ketamine treatment, they typically undergo a series of infusions in the clinic. Typically, Bailey said, patients get six transfusions, but they can receive as many as 10 in rare cases. The Boise Ketamine Clinic also recommends 12 weeks of cognitive talk therapy on an out-patient basis.
"There's no memory loss and no general anesthetic needed. You can do it very safely in the clinic setting and go home the same day with minimal side effects," Bailey said.
The growing body of research into Ketamine as a treatment for depression attracted Dr. Eric Melbihess, who runs the Boise Ketamine Institute. He and a former partner opened the clinic in 2017, where he said they've had an approximately 70% success rate among their patients.
"In my previous life I was a biochemist and had experience with pharmacology and research on drugs and how they affect the human body," Melbihess said. "In medical school, we noticed that people we were giving Ketamine to during anesthesia reported that they had an improvement in mood, especially those with depression."
At Boise Ketamine Institute, patients are given a free consultation to decide if the treatment is likely to be beneficial, and then treatments are scheduled over a two- to three-week period. The results for each person vary, and the effects may last for two weeks to as long as 18 months.
While these clinics and many others across the U.S. have processes in place to encourage patients to try other treatments first, Bailey said Ketamine is given to suicidal patients promptly.
"If someone is suicidal, regardless of a documented diagnosis, that's an acute problem and needs to be fixed urgently," Bailey said. "Research has shown that Ketamine, in as little as one dose and 24 hours, greatly reduces suicidality."
In addition to depression and anxiety, research has indicated that Ketamine can also yield positive results for patients with Obsessive Compulsive Disorder (OCD), chronic pain, mood disorders and fibromyalgia. Its versatility aside, Ketamine is not a miracle drug, and critics point out its side effects, which include addiction, bladder problems and out-of-body experiences that one would expect with a dissociative drug. A quick perusal through the forum "Personal stories" on the Ketamine Advocacy Network site shows that there are plenty for whom Ketamine was not the answer. Posts have titles like "Hit the ground running but then...", and "Return of suicidal thoughts shortly after infusion." But for those who have searched for an answer and found it in this drug, it may indeed feel like a miracle.
User Dan Y. on the Ketamine Advocacy Network found solace after his first six infusions, saying "Every infusion I had was different. Every person has a different experience. I will say that my depression seems to be gone, completely! Don't know if it will last and, at 73, I have a lot of other problems to sort out before the end of it all, but the depression is gone! At least for now. YEAH!!"
If you or someone you know is in crisis or needs support, please reach out for help by calling or texting the Idaho Suicide Prevention Hotline at 208-398-4357. All calls are confidential and anonymous.
By the Numbers:
• 986,000: global suicide victims in the past 12 months
• $1,300 billion: global economic loss due to depression, bipolar, PTSD, anxiety
• $50 billion: global sales of drugs for depression, bipolar, PTSD, anxiety
*numbers from ketamineadvocacynetwork.org