If you google “ketamine clinic near me,” you’ll get a host of targeted ads for ketamine “clinics” with trendy names such as Mindbloom, Field Trip and Nushama.
They offer discounted packages, intravenous or at home treatment and the tantalizing possibility of a one drug cure-all that all offers an alternative path to wellness. The prescribers are usually on-line, nurse practitioners with little interest in the larger psychiatric and medical picture.
Their business model is based on profit rather than improving depression outcomes (lessening depression or reducing the risk of suicide). The more patients they see, the more money they bring in.
Matthew Perry's Death from Ketamine Overdose
The biggest risk of ketamine clinics is drug abuse and addiction. The death of the Friends’ actor Matthew Perry from a ketamine overdose is one recent celebrity example.
From press reports, he had an odd medical set-up. His primary care doctor was an anesthesiologist, which is unusual. He is also the founder of a ketamine clinic called “Ketamine Specialists” who administered ketamine via infusions and prescribed compounded ketamine for at home use (also not standard of care). The autopsy indicated that Matthew Perry had anesthetic levels of ketamine in his system so it seems that he was also abusing it, outside of the prescriber-patient relationship.
FDA Ketamine Warning
In October of 2023, the FDA issued a warning about the misuse of compounded ketamine in tablet, lozenge or nasal spray form. Compounded ketamine is readily available from online ketamine clinics for at home use. The New York Times called it a “fraught new frontier”. The marketing of ketamine as a lifestyle or wellness drug is, in my opinion, particularly misleading.
Intravenous Ketamine and the FDA approved nasal spray, Spravato, when used properly for appropriate indications, have shown incredible results for many patients. They have changed the management of treatment resistant depression (TRD) and suicidality in ways that are often breathtaking.
The American Psychiatric Association Guidelines for Safe Ketamine use
Because it’s such an important psychiatric medication, safe administration of the drug is essential. That’s why I prescribe ketamine by strictly adhering to the American Psychiatry Association’s ketamine consensus statement.
No Home Ketamine Treatment
We don’t offer home treatment.
Our patients are carefully screened. We usually require blood tests, an ECG and medical clearance from Primary Care Providers. Urine drug testing is mandatory.
Each infusion is carefully monitored by a nurse who takes vital signs every 15 minutes. The nurse does not leave the patient’s side for two hours. We have oxygen and resuscitation equipment, although we have never needed to use it.
We start ketamine at a low dose and increase the dosage cautiously. If we detect an issue, we can stop the infusion.
We don’t allow patients to drive until the day after their infusion.
I believe that good communication with primary care doctors offers another safety net, especially when it comes to managing high blood pressure. We often see increased blood pressure during ketamine infusions, and that’s why I require that PCPs monitor persistently high blood pressure.
Ketamine is Not a One-drug-solution
I don’t use ketamine as a one-drug-solution. Instead, I see it as an additional tool to treat depression.
Before giving ketamine, I find that it worthwhile to tweak other antidepressants that the patient is already on. I also order pharmaco-genomic (genetic) testing to see why those previous drugs have not been effective.
Ketamine Offers Hope for Depression
We are seeing about a 75% depression improvement rate and a 50% depression remission rate with IV Ketamine and that’s something to shout about! It offers great hope to sufferers and their families.
In those cases where ketamine does not help, we have other good options such as TMS, transcranial magnetic stimulation, which is a new and very safe non-drug treatment.
In summary, I remain optimistic about treating depressed people with IV ketamine as part of a comprehensive treatment approach that is safe, professional and thorough. It’s not a one-drug-solution but it does have the possibility of reducing depression and suicidal thoughts and that’s something that I am passionate about.
If you are considering treatment with ketamine, ask prospective providers for evidence that they are adhering to the American Psychiatric Association’s ketamine consensus statement. It an important standard for the delivery of ketamine.
