How to Steer Clear of the Ketamine Wild West

Avoid the ketamine wild west

Source: Vecteezy

This article was co-written with Dr. Stephen Manlove, MD

Associated Press reporter Matthew Perrone’s recent article Prescriptions For Ketamine Have Soared in Recent Years, Despite Little Research or Regulation, paints an alarming picture of ketamine use in pain management. Perrone suggests ketamine for pain could morph into the next opioid crisis. While we share some of Perrone’s concerns, ketamine has, in fact, become a vital tool for alleviating depression, anxiety, and PTSD when used under the right conditions.

Ketamine and its FDA-approved derivative, Spravato, help stabilize patients with severe depression who have not found relief from other medications or therapies, but they may be dangerous if not used as a component of comprehensive mental healthcare.

Prescribers who do not use ketamine and Spravato as part of comprehensive mental healthcare increase the risk of negative outcomes for their patients and spread fear about these medications that can be used safely and are life-saving for many people.

Ketamine and Spravato are powerful and important drugs and, when used in the right context, the benefits significantly outweigh the risks. However, you should be wary of where you get ketamine. Not all ketamine clinics are equal. If you or someone you love is looking for ketamine treatment for mental health, here’s what to look for in a ketamine provider:

• Commitment to proven safety standards. There are well-established safety guidelines for ketamine. To be confident in the safety of your treatment, find a provider that follows the Risk Evaluation and Mitigation Strategy (REMS) protocol which was developed for the FDA-approved nasal spray Spravato, a derivative of ketamine. They should also be compliant with the stringent American Psychiatric Association guidelines for administering ketamine.
• Full-spectrum care. Avoid “ketamine shops” that focus on ketamine alone. If you are looking for long-term relief for depression, anxiety or PTSD, look for a clinic that offers ketamine along with other mental health treatments such as transcranial magnetic stimulation, vagal nerve stimulation (VNS), electroconvulsive therapy (ECT), medication management, lifestyle medicine, and psychotherapy. The clinicians in those clinics can help you develop a treatment plan out of the many options available that best meets your needs.
• Psychiatrist oversight. If you are looking for ketamine for depression or another mental health condition, you should see a psychiatrist who offers ketamine as part of comprehensive mental health treatment. Psychiatrists have the medical expertise to manage potent medications and the psychological knowledge to know when to use them safely and how to deal with psychological complications these mental illnesses and their treatments may cause. We are concerned that clinicians who lack either or both of these skill sets may inadvertently endanger severely depressed patients.
• In-office treatments only. Prescribers who offer ketamine via telemedicine bypass many of the safety measures needed to prevent addiction and abuse problems. We believe, and the FDA and the American Psychiatric Association agree, that ketamine should only be administered in a healthcare setting.
• Emphasis on a medically safe and comfortable treatment experience. There are ways to increase the likelihood that you will have a positive experience during treatment with ketamine, such as providing a safe, warm, and comfortable environment, listening to music without lyrics, and working with your provider to adjust your dosage during treatment as needed.

As a life-changing drug for people with treatment-resistant depression, anxiety and other mental health conditions, few treatments are as powerful as ketamine. We hope the above points give ketamine patients assurance that they're not headed into wild, uncharted territory. Make sure your mental health team has the depth of mental health experience, is competent in managing complex conditions and medications and follows existing guidelines.