Ketamine, a powerful anaesthetic drug, has found its way into the spotlight for all the wrong reasons.
Once confined to the operating room, this dissociative substance is now being touted as a miracle cure for a host of mental health issues, from depression to anxiety. But the reality is far more sinister.
The off-label and recreational use of ketamine has skyrocketed in recent years, with clinics and telehealth companies aggressively marketing the drug for unapproved treatments.
This is a dangerous gamble, as ketamine can have severe side effects, including hallucinations, mood changes, and even respiratory depression that can lead to death.
Ketamine was originally developed as a battlefield anaesthetic during the Vietnam War, and the FDA has only approved it for use as a general anaesthetic in controlled supervised medical settings.
Yet, thanks to a loophole in marketing laws, clinics are now offering ketamine infusions for a wide range of conditions, from Lyme disease to alcoholism, with little to no oversight.
This reckless approach to mental health treatment puts patients at serious risk. Ketamine can cause cognitive impairment, making it difficult for individuals to make rational decisions while under the influence.
And the lack of comprehensive follow-up care at these clinics means that patients are left to navigate the aftermath of their ketamine experience alone.
The South African Society of Psychiatrists (SASOP) raised concerns about the recreational or unsupervised use of ketamine. This drug, which has shown promise as a treatment for severe depression that hasn't responded to traditional medications, is gaining attention worldwide.
Dr Bavi Vythilingum, a psychiatrist and SASOP spokesperson, explained that "there is good evidence that ketamine in low doses, administered under controlled conditions with the necessary medical supervision, is an effective treatment for treatment-resistant major depression".
It can also be helpful in urgent situations involving suicidal thoughts, providing quick relief from life-threatening risks.
However, Vythilingum warned that ketamine is a powerful anaesthetic. High doses can lead to sedation or even loss of consciousness, and extremely high doses could slow breathing to dangerous levels, potentially leading to death.
Even at lower doses, without proper supervision in a safe environment, users might become confused and accidentally harm themselves. Additionally, ketamine has the potential for addiction and abuse.
Over the past two decades, evidence has emerged supporting ketamine’s effectiveness in treating adults with treatment-resistant depression when used in sub-anesthetic doses.
With this, Vythilingum expressed concern about the increasing number of independent clinics offering ketamine treatments.
She highlighted issues around correct diagnosis and whether ketamine is the right choice, as well as the need for monitoring potential side effects.
Vythilingum reiterated that ketamine is only intended for adults with treatment-resistant depression, as there is no supporting evidence for its use in children.
While some have suggested that ketamine might help with other mental health issues like post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD), SASOP cautioned that scientific support for these claims is limited.
Understanding Ketamine therapy for depression v traditional treatment
Ketamine works differently from traditional antidepressants, which some medical researchers believe is part of why it can be effective when other treatments have failed.
During treatment, ketamine is usually given through an intravenous infusion, or drip, over a period of 40 to 50 minutes.
Patients are monitored closely and need time to recover afterwards. It is advised that someone else picks them up after the session, as they should not drive until they have had a full night’s sleep.
Typically, patients undergo an initial series of six sessions within two to three weeks. Depending on individual needs, the psychiatrist may suggest ongoing maintenance treatment.
The effects of ketamine can lead to what is often described as a dissociative state, similar to a “trip”.
This experience can include feelings of being in a trance, having an out-of-body experience, sensory distortions, and even euphoria.
While some of these dissociative effects can help relieve depressive symptoms, there are potential negative side effects too. These can include nausea, vomiting, increased blood pressure, slowed breathing, sedation, and even loss of consciousness.
Long-term use of ketamine at high doses can lead to serious health issues such as bladder and kidney problems, liver damage, and stomach pain, as well as the risk of addiction, which may require higher and potentially dangerous doses over time.
Vythilingum stressed that ketamine should only be prescribed by a psychiatrist. This is because a proper diagnosis of treatment-resistant depression must be made, typically after at least two rounds of conventional antidepressants have failed to improve symptoms.
The administration of ketamine must also be done by a medical doctor, ensuring both physical and psychological safety during the process. SASOP advises that the guidelines from the South African Society of Anaesthesiologists (SASP) be followed.
These guidelines state that the doctor giving ketamine should be an anesthesiologist or a registered sedation practitioner trained in advanced cardiac life support and resuscitation.