Illustration by Cate Andrews
As a nation, we’re struggling with mental health. According to the Centers for Disease Control and Prevention, suicide rates declined in the United States in 2020 during the early days of the COVID-19 pandemic but rebounded in 2021 to 14.5 deaths per 100,000 people. That eclipsed a pre-pandemic peak in 2018 of 14.2. In general, 1 in 6 people will have depression at some time in life. Some will not respond to talk therapy or prescribed medication.
Results of a study published in the September 2022 Journal of Clinical Psychiatry show that regular infusions with the drug ketamine offer relief to people suffering the most with treatment-resistant depression and generalized anxiety symptoms and may also prevent suicidal ideation.
The study — a collaboration between Dr. Albert Arias, an associate professor of psychiatry at VCU Health, and Dr. Patrick Oliver, founder and medical director of the MindPeace Clinics in Richmond — measured both symptom improvement and remission of symptoms. Patients received a low dose of ketamine over 40 minutes via IV drip.
Patients with suicidal ideation experienced dramatic improvement. “At six infusions over two weeks, 50% [of those in the study] were no longer suicidal,” Oliver says. “After 10 infusions, 75% were no longer suicidal. That’s compared to [prescription] pills, which might take two months to work with less than half the efficacy. In two to three weeks, we’re fixing this problem.”
Study participants experiencing treatment-resistant depression and generalized anxiety also saw relief with 72% and 30% response rates, respectively.
Arias notes that while the study wasn’t a randomized clinical trial, the large number of patients — 424 — lends weight to the results. “It’s technically a case series, so not as strong [as a clinical trial], but still a useful type of trial that tells us some information,” he says, noting that additional research will use a larger cohort to see if the results hold.
Developed in the 1960s, ketamine is used as an anesthetic for people and animals. Ketamine is structurally related to PCP and can produce hallucinations. It has been used as a party drug, often referred to as “Special K.” Over the past two decades, research on its use to relieve depression has increased. In 2019, the Food and Drug Administration approved Spravato, a ketamine-based nasal spray, for use in treating depression.
The cost for ketamine infusions is about $500 per 40-minute session; they are offered locally at clinics including Oliver’s MindPeace Clinics and at Alchemy Wellness in Henrico. Infusions aren’t covered by insurance because they haven’t yet been approved by the FDA. Spravato may be covered, depending on the individual’s health insurance plan.
As interest has increased, so has the number of businesses that offer ketamine delivered through lozenges or injections, which may not have the medical underpinning used in their study, Oliver and Arias say. “[These treatments] were done under the care of licensed physicians,” Arias says. “Patients aren’t given a supply to take home with them to take however they want.”
Oliver adds, “We have to give the medication in the right amount, in the right concentration, to get the right effect. The problem with oral delivery at home is that when you take it by mouth, it goes through the liver, and you have 10% to 20% absorption. And some people have reactions where they are spooked by it. Some people like the experience of roller coasters; others don’t.”
(From left) Registered Nurse Brittany Harding and Dr. Patrick Oliver with patient Sharon Nowak (Photo by Ash Daniel)
Grace, a patient of Oliver’s whose last name has been withheld to protect her privacy, found MindPeace Clinics through an online search. She was diagnosed with major depressive syndrome in college. Over the years, she had tried various treatments, including selective serotonin reuptake inhibitors (SSRI) medications and talk therapy. She was aware of ketamine’s use to alleviate symptoms but didn’t pursue it until she reached a breaking point in November 2021.
“I thought I wasn’t going to be able to make it through the holidays,” she says. “I was nearly bedridden, with feelings that I’d be better off dead. I’d spent 30-plus years dependent on multiple medications to control depression and anxiety, which were ineffective, but that’s all there was. My mindset was pure desperation. There was nothing left for me to try.”
Grace began treatments before Thanksgiving and had the last session in early December 2021. “I felt completely changed; it was amazing,” she says. “I was shopping, I was wanting to go to holiday parties. Words came easily, my brain fog lifted.”
Because of her anxiety, Grace takes anti-anxiety medication before an infusion, recalling how her first treatment was unsettling. “There is a moment where you begin to dissociate, when you feel like putting your foot on the floor to ground yourself,” she says. “When you relinquish that control, I find it to be incredibly peaceful. I can see why people would feel like this is a spiritual thing.”
Since her first round of infusions, Grace has returned to the clinic for four “boosters,” using a mood monitor app to identify when her mental health starts to decline. “Everybody’s different,” she says. “I had hoped that after the first six sessions, everything would be gone; I wasn’t considering that I might need more maintenance. I think because of the severity [of my condition] and where I started, it makes sense that [my issues] wouldn’t just go away.”
Arias says that the recent study doesn’t consider how long treatment effects will last. “We think the majority of people will need boosters, maybe monthly or every couple of months. It varies by person.”
One thing the study does is reassure both patients and practitioners. “This is the type of scientific investigation that academics like to do,” he says. “The treatment remains somewhat controversial within the field. Some prominent psychiatrists on the national level have made statements cautioning about it. There are bits of wisdom in that. On the other hand, it’s an emerging treatment. This is something that adds to the evidence base.”
Oliver says he knew ketamine treatments were helping his patients. The benefit of the study is that it provides data that can be presented to skeptics in the psychiatric community.
“It’s a different key to the lock, or, more accurately, a different set of transmitters, GABA and glutamate,” he says. “These mood disorders are brutal. With [ketamine infusions], we are encouraging the nerve to release growth protein that tells the nerve to regrow connections, or synapses, amongst themselves. It’s neuroplasticity, regrowing dendritic spines so the nerves can communicate effectively. This is why we’re so excited. I’ve had patients suffering with depression for 40 years; they do treatments with us for two weeks, and they get better.”
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