Business of using ketamine to treat depression, PTSD, other ailments is growing
July 11, 2018
RENO, Nev. — Dr. Robert Watson was walking to the hospital one day when he heard a woman call out to him.
The woman, he quickly realized, was the mother of a patient whom he recently treated.
"She told me, 'Oh my gosh! Thank you; thank you so much!'" Watson recalled.
Not long before, the woman had called Dr. Watson's office out of desperation. She was seeking help for her daughter, who was suffering from an anxiety disorder — she was crippled by it and unable to work.
And so, on a day off, Dr. Watson opened up his clinic. After a screening process, the young woman was taken into a cozy low-lit room, where she sat in a reclining chair, and given an IV infusion for 45 minutes.
This wasn't any ordinary IV drip, though. Moving through her veins was a drug that a growing body of research shows may be a new hope for mental health conditions: ketamine.
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"A lot of times it's like somebody flipped the lights on. It's a world of change," says Dr. Watson, sitting in his office at Sierra Ketamine Clinics at 15 McCabe Drive in south Reno, during an early July interview with Healthy Beginnings.
"We've had a great number of patients come in with suicide ideations — they see no hope — and we've completely turned them around (with ketamine therapy)," Watson said.
A new hope
Created in the 1960s, ketamine, a derivative of PCP, was initially used as an anesthetic for wounded soldiers on the Vietnam battlefields. In 1970, the federal Food and Drug Administration (FDA) approved the drug as a sedative for patients during medical procedures.
Decades later, it became more commonly known for its use outside of the operating rooms — specifically, as a recreational drug at nightclubs. Due to its hallucinogenic effects, ketamine is widely used in powder form as a psychedelic club drug called "Special K."
Which begs the question: How has ketamine gone from the ER to the club to clinics treating people with mental health conditions, such as anxiety, depression and PTSD?
"(Researchers) were studying pain patients and found that pain and depression often go together," said Watson, a retired general surgeon. "When they would treat patients for pain with ketamine, they found their mood would often markedly flip; their depression would be cured essentially overnight."
Doctors can prescribe ketamine off-label for any condition they believe it may help, including depression, since the drug is FDA-approved as an anesthetic.
When infused at low doses into patients with life-threatening depression, ketamine induces neuroplasticity and synaptogenesis in patients' brains, Watson said. In other words, ketamine causes physical changes to the neurons in the brain, as opposed to just a chemical change that fades after a drug is metabolized, which is the case for typical antidepressants.
Moreover, the effectiveness of antidepressants is underwhelming and the number of side effects associated with them can often be overwhelming. In fact, Time magazine in August reported that an estimated 300 million people worldwide suffer from depression, and one-third of them don't find relief from antidepressants or other treatment options.
And suicidal thoughts can strike quickly and without warning in people who live with the disease.
This is why Watson sees ketamine treatment as such a game-changer, not only because of its efficacy, but also the speed at which it can work.
"We get such a dramatic and unquestionable benefit from ketamine compared to the kind of marginal or lackluster improvement or delayed improvement from the typical antidepressant medications," said Watson, pointing to the fact that antidepressants take weeks or months to kick in and ketamine, for some, can take mere hours. "Some people clearly benefit from antidepressants, and I don't want to say that there's no role for them. It's just that ketamine is like a new level.
"It's a whole paradigm shift in treatment of refractory mood disorders."
Some patients can be treated in as little as four to eight weeks before recovery, although other cases may take three to six months.
Since opening last fall, Sierra Ketamine Clinics in Reno has treated a couple hundred patients, Watson said.
"The doses that we use for ketamine therapy is really low compared to what we would use for anesthetic," Watson said. "It's believed that an induction series — or two infusions per week for two to three weeks — really causes this outburst of neural growth. After the induction series, the benefits of the treatment last oftentimes for a few weeks."
Dr. Watson said ketamine is also used to treat pain as an alternative to opioids, and has a much lower risk for addiction and abuse.
"Ketamine acts much longer than the opioids," Watson said. "Patients will get a sustained benefit from ketamine infusion. And then we don't have problems with addiction because you're not taking it multiple times a day every day."
The future of ketamine
The FDA has yet to approve ketamine as a treatment for pain and mood disorders. In addition, insurance companies do not cover ketamine treatments — at least not yet.
Watson, though, said he anticipates ketamine will eventually be approved by the FDA as treatment for mental health disorders. What's more, he said it could be brought to market as a prescription drug within a few years.
Currently, pharmaceutical giants Johnson & Johnson and Allergan are working on getting regulatory approval for depression drugs inspired by ketamine. If approved, they'd be the first new drugs for depression in 35 years.
"So will there be a need for ketamine clinics after these new drugs come out? That's yet to be determined," Watson said.
Until then, Watson said he hopes those suffering with severe mental disorders continue to consider ketamine therapy as a treatment option.
There are approximately 50 other ketamine treatment clinics nationwide, but Sierra Ketamine Clinics is one of only a handful in the West.
"I think a ketamine clinic is beneficial because the population doesn't have better alternatives at this point," Watson said. "Antidepressants work for a lot of people, but there's a lot of people that they don't work sufficiently well for.
"A great number of our patients who come in, who don't get enough relief from their depression while on antidepressants, respond beautifully to ketamine."