Ketamine gives hope to patients with severe depression, though uncertainty remains

Ketamine clinics, where the powerful anesthetic drug is used to treat depression and dozens of other disorders, have cropped up across the United States in recent years. An investigation by STAT, however, finds that they are all over the map in terms of what they offer, to whom, and how.

Ketamine clinics, where the powerful anesthetic drug is used to treat depression and dozens of other disorders, have cropped up across the United States in recent years. An investigation by STAT, however, finds that they are all over the map in terms of what they offer, to whom, and how. In fact, many are in noncompliance with American Psychiatry Association (APA) guidelines released in 2017. The organization specified the kind of training it thought physicians should have—including advanced cardiac life support certification, due to the potential impact on heart rate or blood pressure—and offered steps for patient screening, including a comprehensive diagnostic assessment, a full review of past depression treatments, thorough examination of medical and psychiatric records, and an informed consent process that clearly discloses the risks and limitations of a drug that still has many unknowns. Based on its probe—which included interviews with clinic owners, psychiatrists, and patients—STAT found that patient screening is inconsistent; clinics frequently are not coordinating with mental health experts and patients' other providers on care; and some outfits exaggerate the benefits of ketamine and often use it in settings that have not been thoroughly investigated. As a result, experts worry that patients are being over-treated, treated simply because they can afford the high cost, and treated even when ineffective. Additionally, they may not be receiving the collaborative and follow-up care they need.