Magic Medicine?

Magic Medicine?

Patients are turning to ketamine and other psychoactive drugs for mental health treatment

Sarah Jones, a 42-year-old stay-at-home mom in Woodstock, has struggled with depression since childhood. She’s tried multiple antidepressants and therapies over the years, and last fall, her medications once again quit working. Then Jones heard a radio ad about a new approach for depression — a drug called ketamine.

Ketamine is an anesthetic commonly used by veterinarians. It’s also used illegally as a club drug for its mind-altering, euphoric effects. And recently, it’s been touted for a new use: treating depression. 

Other psychoactive drugs like Ecstasy, LSD and magic mushrooms are also being considered as treatments for mental illnesses. Some of the drugs are under consideration for approval by the Food and Drug Administration (FDA).

Ketamine goes mainstream

Over the past several years, ketamine clinics, which deliver the drug to patients through intravenous (IV) infusions, have sprung up in Chicago and around the country to treat depression and other mental health conditions, including post-traumatic stress disorder (PTSD) and anxiety. 

Using the drug this way is considered an off-label use, meaning it’s used in a manner different from what’s been specified by the FDA. IV ketamine treatments for depression are not approved by the FDA and are often pricey. They are typically not covered by insurance. 

In March 2019, the FDA approved a nasal-spray version of ketamine, called esketamine (marketed as Spravato), to help the estimated 5 million Americans whose depression hasn’t responded to other treatments. Research shows that ketamine can more rapidly turn around depression than traditional antidepressants. Suicidal patients can find their urge to harm themselves quelled within 24 hours, rather than the weeks or months it takes a drug like Prozac to take effect, researchers have found.

“It’s a bold move by the FDA to approve a completely new class of antidepressants and to open up a new realm of drugs that are considered psychedelics and psychoactive to be used as a medical treatment for something as common as depression,” says Bal Nandra, MD, an anesthesiologist and founder of IV Solution, which for almost three years has provided IV ketamine in downtown Chicago. 

Nandra hasn’t decided whether to offer the recently FDA-approved esketamine nasal spray in addition to IV ketamine. “It’s not nearly as effective or rapid acting as IV ketamine,” he says.

Lifting depression 

Jones received IV infusions of ketamine at Nandra’s South Dearborn Street clinic in November 2018. She followed Nandra’s typical regimen of six treatments given over a period of about two weeks, at a price of $500 to $600 per infusion. 

During these sessions, patients are seated in a private room, where they are hooked up to an IV for about 45 minutes, usually reclining on a medical lounge chair with the room darkened. Often, they wear an eye mask and listen to music. Patients are monitored by nurses or other staff for side effects, and those who become anxious may receive some sedation. After the infusion is over, patients are observed for about 30 to 45 minutes before being released. 

Ketamine can cause patients to feel dissociated from their bodies. The experience left Jones with a sense of the vastness of the universe and the idea that “there is something more out there than what we experience in our everyday life,” she says. “It almost takes you away from your suffering.” 

Most patients feel better after the first few ketamine infusions, Nandra says, though some take longer. Jones felt her depression lifting after her first treatment.  

It’s a bold move by the FDA … to open up a new realm of drugs that are considered psychedelics and psychoactive to be used as a medical treatment for something as common as depression.”

Jones returns to IV Solution every two months for one-session booster infusions to keep her depression at bay. 

She has been able to dramatically reduce her antidepressant use, while continuing in therapy. 

“Ketamine not only restored my brain to being able to function but also gave me insight into some life choices that were adding to my depression,” Jones says. Today, she adds, 

“I don’t remember what depression feels like. I’m so happy!” 

Gregory Teas, MD, a psychiatrist with the AMITA Health Behavioral Medicine Institute, says the clinic will likely start offering esketamine treatment starting this fall. Esketamine has a wholesale cost of $590 to $885 per dose, but the treatment may be covered by insurance, Teas says. Patients can’t take it at home but must go to a medical facility, where it is given under strict protocols, including two hours of monitoring afterward. 

Like other experts, Teas cautions that long-term studies on the use of ketamine and esketamine are needed. While the drug primarily works on receptors in the brain’s glutamate system, it also uses opioid and dopamine pathways, he says, which means it could be addictive for some patients.

Exploring other possibilities

Other psychoactive drugs may soon join ketamine as treatments for psychiatric conditions. The University of Chicago’s Human Behavioral Pharmacology Laboratory, directed by Harriet de Wit, PhD, has been studying MDMA (also known as Ecstasy) as a possible treatment.

MDMA, which causes people to feel loving toward themselves and others, may be helpful for people with PTSD and autism-related social anxiety, says researcher Anya Bershad, MD, PhD, who recently left the lab to complete a psychiatry residency at the University of California Los Angeles. 

A national phase 3 clinical trial of MDMA used in conjunction with psychotherapy for PTSD is underway, though Chicago is not a study site. If these trials go well, researchers expect the FDA might approve MDMA in 2021 for use with psychotherapy as a treatment for PTSD. 

Also being studied at the University of Chicago: microdosing with LSD to treat depression and anxiety. Study participants receive one-tenth or one-twentieth of a recreational dose, usually every three days, Bershad says. They don’t experience mind-altering psychedelic effects, but they do report feeling the “experience of unity,” even at those tiny doses, she says.

Other labs outside Illinois are studying psilocybin, or magic mushrooms, for their potential in treating anxiety, depression and eating disorders. Medical marijuana is also being researched for the treatment of PTSD, though studies differ so far on its effectiveness. 

As for ketamine, Nandra says in the years he’s been offering IV ketamine treatments he has seen many patients recover. “For these people, it lasts,” he says. “They do great. Their lives completely change. … It’s pretty amazing.”

Originally published in the Fall 2019/Winter 2020 issue.