Ketamine Seen As Possible Breakthrough Drug For Treating Range Of Mental Health Issues
By Juliette Goodrich & Molly McCrea
SAN LEANDRO (KPIX) -- Following the pandemic, mental health experts are predicting a tsunami of psychiatric illness. While COVID-19 may feel under control, many people are feeling mentally off - chronically exhausted, burned out, anxious, quick to anger, and depressed. One treatment offers hope but it's not without controversy.
It's called ketamine. North Bay artist Julia Whitty has tried it. For years, she's struggled with debilitating post-traumatic stress disorder (PTSD) and severe depression.
"It impacts everything in your life. Your ability to feel optimistic, to look ahead, to feel happiness, to feel motivation. All of that is squashed," explained Whitty.
Her doctors prescribed traditional antidepressants. Some were helpful up to a point. Then, she tried ketamine, approved by the U.S. Food and Drug Administration more than 50 years ago. The drug helped her navigate the extreme isolation, trauma, and stress of COVID-19.
"It's like a skylight has been opened onto my brain. I feel brighter. I feel more optimistic," said Whitty. "I shudder to think if I had gone thru the pandemic without the ketamine."
Ketamine is a powerful anesthetic that is used in war zones, emergency rooms, pain clinics, and in veterinary medicine. But in San Anselmo, it is used to treat the mind.
"It's the best antidepressant we have, especially embedded in psychotherapy," explained Dr. Phil Wolfson, medical director at San Leandro-based Center for Transformational Psychotherapy. He is also a researcher and co-author of "The Ketamine Papers."
At the center, therapists use ketamine "off label" for medical conditions it's not approved to treat. The practice is common and legal.
"We're using it as an off-label treatment for depression, anxiety, post-traumatic stress, and other mood concerns," explained therapist Melissa Whippo.
Patients take a low-dose lozenge or get a shot in the arm. The dose is much smaller than one would get for anesthesia. The psychotherapy session can last up to three hours.
"This is a tool for people to start addressing trauma in a really safe way," commented psychotherapist Julane Andries.
"It's like you're going into a deep dream," explained Wolfson.
It's a mind-altering experience. The U.S. Drug Enforcement Agency classified ketamine as a hallucinogen. It distorts the senses, can put you in a trance, and is capable of producing a full out-of-body experience.
"I had a little trepidation when I first came in to use it," said Whitty. "But actually, the feelings for me have been so euphoric, and so blissful and so warm and relaxed, I don't have fear about it at all anymore."
The psychotherapists believe the psychedelic trip is key. They call it a "time-out."
"When you come back from your journey, you come back with what we call "new mind," so you have a different perspective," said Whippo. "You're no longer stuck in the loop of whatever it was, rumination with depression, some trauma that keeps repeating, a relational issue that you can't quite break through. That time-out is really helpful and instructive for the reconstructing of the mind."
New treatments for depression, anxiety, and trauma are desperately needed. KPIX 5 spoke with Dr. Lawrence Park with the National Institute of Mental Health (NIMH) is part of the National Institutes of Health.
At NIMH, Park works at the Intermural Research Program, specifically in the experimental therapeutics and pathophysiology branch. His group's mission is to research mood disorders, especially depression and to try to develop new treatments.
"While we do have good drugs to treat depression and in general, they're fairly safe, they don't work all the time," noted Park.
Park says the evidence shows current medications may work only half to two-thirds of the time. In addition, for one-third of people, their depression will persist despite repeated and multiple trials of different medications. SSRIs or selective serotonin reuptake inhibitors may take weeks to show any benefit, and more than 80% of patients prescribed one of these drugs will stop using them within a month's time.
Park said ketamine provides rapid relief - within an hour or two - to people who have not responded to other medicines. The results persist for about a week.
"The discovery of ketamine being an effective antidepressant was really one of the major breakthroughs in the past 50 years," said Park.
However, he is concerned about the widespread "off label" use of the drug and has this advice for our viewers.
"What I would say to patients is to be really cautious about thinking about using them," said Park.
Park pointed to clinics popping up that offer IV infusions of ketamine. The treatment which can be costly is not always covered by insurance. But what may be more concerning, he said, is that these clinics may operate without a qualified mental health professional on site.
"You really want to have a behavioral health professional involved," said Park.
The FDA did approve a nasal spray made from a chemical cousin of ketamine for use in patients with persistent depression. The nasal spray must be used in a medical doctor's office under supervision.
In addition, ketamine has been abused for years as a party drug.
"On the street, it took on the moniker of 'Special K,'" said Dr. Alan F. Schatzberg, psychiatrist at Stanford Health Care and the one-time president of the American Psychiatric Association.
Dr. Schatzberg lead a research team at Stanford that looked into the antidepressant nature of ketamine and discovered the drug may activate the body's opiate system to treat depression.
The study was published online by the American Journal of Psychiatry. The research team is urging caution and pushing for more research into the drug's mechanism of action and its risk of tolerance, abuse, and dependence.
"We don't know how to optimize the benefit and limit the risk and we don't even know what the long-time risks are," explained Schatzberg.
Stanford psychiatrist and neurologist Dr. Nolan Williams, also a member of the research team, told KPIX 5 that the drug does not work for everyone.
"I think there's a role for it but it's not an intervention that's going to be the holy grail that treats everyone's depression," said Williams.
Wolfson believes ketamine's 50-year-clinical record supports its safety and has seen no evidence of dependence in patients.
As for Whitty, she says she's never felt a craving for the drug or felt dependent on it. She is grateful for the treatment and calls it a very positive experience.
The Center for Transformational Psychotherapy just got approval to begin a ketamine trial with hospice patients who have a year or less to live. The research team just published a study on ketamine and its use in psychotherapy known as "Ketamine Assisted Psychotherapy" (KAP).
The report, published in the Journal of Psychoactive Drugs, gathered the clinical data and outcomes from three large practices that offer KAP. The paper suggests that KAP is an effective method for decreasing depression and anxiety in a private practice setting. The benefits were especially notable for older patients and those with severe symptoms.
