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Key points
- Concerns about ketamine's safety as a treatment for severe depression have arisen lately due to a general lack of data.
- Whether ketamine might lead to addiction or bladder dysfunction seems to be a concern only at high levels of usage and low-supervision settings.
- While more research is needed, in general, ketamine treatment for severe depression appears safe.
- The risks of severe depression need to be appropriately weighed again potential risks about ketamine therapy.
In February 2023, an extensive article published in The New York Times raised questions about the safety of ketamine, a treatment for severe depression and suicidality that has been gaining more ground recently. The article interviewed dozens of patients and clinicians and cited concerns, especially around addiction, bladder dysfunction, and lack of long-term safety data. The article ultimately called ketamine a “fraught new frontier” in treatment for depression, in large part because of these concerns. But what does the existing evidence say about each of these concerns?
First of all, it is important to note that experts interviewed for the Times piece did say that these outcomes were exceedingly rare at the doses and frequencies that most patients receive ketamine. The concern really stems from at-home treatments in which some people end up getting more ketamine than they should.
This brings us to the first concern: addiction.
How common is an addiction to ketamine among people who receive the drug in the traditional way, e.g., through a licensed provider at a clinic or infusion center? Research shows that ketamine addiction after use in a treatment center for depression is exceedingly rare. It is true that ketamine can be addictive when used recreationally, but as far as these things go, ketamine is generally less addictive than alcohol, nicotine, and opioids. So it has a potential for abuse, but the abuse potential is relatively low in most people seeking treatment for depression and receiving ketamine in a controlled manner.
The question is a bit murkier for the home use of ketamine for depression, which is gaining popularity. In these cases, the highest risk probably still lies with people who have experienced other addictions. Caution should be taken in these cases, both in the clinic and at home.
Onto the second claim: Does ketamine cause bladder dysfunction?
Ketamine bladder disorder or ketamine-induced cystitis is a painful condition that causes urinary frequency and urgency and pelvic pain or pressure. However, this condition generally occurs only with very high drug usage, much higher than most patients are getting in the clinic. Once again, this is an exceedingly low risk in controlled conditions but can be more of a risk if people receiving the drug at home are abusing it.
As for the long-term effects of using ketamine for depression, it is true we do not have decades of data to confirm long-term safety because the drug has only been used for treatment-resistant depression more recently. However, even this concern needs to be put into perspective. Ketamine for treatment-resistant depression is indicated for people who have not responded to a wide range of antidepressants and other evidence-based treatments for depression or have significant suicidal thinking, impulses, and behaviors. In many cases, people’s lives are absolutely hanging in the balance, and ketamine is a treatment option that can offer significant relief for some people from a severe, debilitating, and life-threatening illness. For that reason, many people suffering from severe depression who don’t respond to other interventions may decide to undergo ketamine treatment.
Any medication comes with risks and benefits, of course. In this case, the threat to the lives of many patients suffering from treatment-resistant depression may be too great to ignore.
