Illustration by Maria Fabrizio
Patrick Oliver was sad, frustrated, and had an unenviable task before him.
He was working as an emergency room doctor and was unable to save the life of a woman who had committed suicide. Now, he had to tell her husband, who was left with two children to raise, what had happened.
He was unable to help this woman, but he wanted to do something — anything — to help others.
“I want to keep people from killing themselves,” says Oliver, a physician and medical director for the Mind Peace Clinic in Richmond.
He began to research ketamine, an anesthetic that has been used for decades but has also been abused as a party drug. It’s been used off-brand by doctors and researchers to treat people with conditions including chronic pain, post traumatic stress disorder and anxiety, and to help people with intractable depression, severe depression that does not respond to other medications or to talk therapy.
Ketamine is administered by IV at Virginia Commonwealth University Medical School, but it has only been used in a handful of patients coping with major depression who are not getting better, according to Ananda Pandurangi, director of the schizophrenia program and director of the brain stimulation therapy program in the VCU Health Department of Psychiatry. About half have improved, says Pandurangi, and they need to continue with other medications and therapies in addition to the infusions.
“We do a little of it,” he says. “We don’t promote this, or tell people we are doing it.”
Oliver treats people with infusions of ketamine in office, with a nurse on staff to provide care.
Over a year and a half at his practice in Richmond and in Northern Virginia, Oliver says, he has treated about 1,000 people. He claims the drug helps up to 75 percent of his patients.
Oliver has treated all ages, beginning at age 12. He cites the successes he’s seen, such as the woman who had been on some 16 medications and had coped with 25-plus years of chronic migraines, or the patient who spent Easter planting flowers in her landscape after spending decades basically in bed without energy because of severe depression.
“It’s giving these patients their lives back,” he says. “For a select group of patients, this can be a substantive game-changer.”
WHAT YOU NEED TO KNOW
ABOUT KETAMINE: Ketamine has long been used as an anesthetic, especially for short-term procedures such as colonoscopies, according to Ananda Pandurangi, director of the schizophrenia program and the brain stimulation therapy program in the VCU Health Department of Psychiatry. About a decade ago, it was found to have antidepressant effects, and it recently was found to modulate pain. Pandurangi notes that the antidepressant effect may be noticed within a few hours to a day later. Treatment regimens are still being pursued and looked at by researchers in trials.
ESKETAMINE: Earlier this year, the U.S. Food and Drug Administration approved a cousin of ketamine, known as esketamine, in a nasal spray form for use in treating people with severe depression. Ketamine has not received FDA approval as a treatment for pain or depression and is used off-label by physicians.
TIME: Infusion treatment sessions take about 90 minutes, and the spray esketamine sessions may take about two to two and a half hours, according to Oliver of the Mind Peace Clinic.
WHO MAY BE HELPED: People with treatment-resistant depression (about one-third of the 300 million people worldwide who live with major depressive disorder); people with bipolar disorder; people with traumatic stress disorder; those with suicidal thoughts; chronic pain patients.
COSTS: Health insurance generally does not currently cover administration of ketamine or esketamine. National Public Radio in March reported that Johnson & Johnson, which makes the nasal spray esketamine under the brand name Spravato, has a wholesale price of $590 to $880 per treatment, depending on the dose. Infused ketamine treatments cost about $400 to $800 per treatment, according to ketamineadvocacynetwork.org.
SIDE EFFECTS: Some nausea or dizziness or an increase in blood pressure. Disassociation, in which perceptions of yourself can be altered; a feeling of being outside of your body, or you may forget your identity for a few minutes. It’s rarely seen, but may occur during the infusion process. Also, temporary psychosis may occur (1 or 2 out of 100 reports in the literature, according to Pandurangi) and, rarely, seizures.
BRING A BUDDY: You can’t drive for 24 hours after a treatment.
STUDIES: In 2015, Pandurangi was part of a research team at VCU that published a study in the journal Clinical Neuropharmacology involving a patient with treatment-resistant depression (TRD) who went into remission following ketamine treatment, “the first case of long-term ketamine efficacy as augmentation therapy in TRD over the course of 18 months,” they wrote.
