Anesthesia drug works on severe depression, but off-label use raises concerns

Anti-depressants work for only about half the people taking them, leaving the unlucky half to quickly run out of options. Some psychiatrists are exploring the off-label use of the common anesthesia drug Ketamine, which has shown promising results, but is also raising concerns.

Researchers aren’t quite sure why or how Ketamine works for people with depression. As an anesthesia drug it seems like an unlikely candidate in treating depression, and it has a nefarious second life – it’s known as the hallucinogenic street drug “special K”

Still, several studies have shown that it does work, quite dramatically. The Ketamine buzz caught the attention of New Jersey psychiatrist Steven Levine, who had long been frustrated with not being able to offer more options to some of his patients with treatment-resistant depression. “These folks never even get included in studies, because people don’t expect them to respond,” explained Levine. “So here’s this population that never gets studied. Everybody would expect they would not respond, and they are responding dramatically, at high rates very, very quickly!”

In several studies, over half of patients experienced significant improvement of their symptoms. After delving into the available research, Levine decided to open the Ketamine Treatment Centers of Princeton – the only outpatient clinic offering this service in New Jersey – and one of about 20 or so in the country. Levine has treated several hundred people over the past three years. They receive injections of Ketamine, the amount is significantly smaller than what a patient gets during anesthesia.

Lynn Bates of Sanatoga, Montgomery County made the two hour trip to Levine’s clinic on a sunny November morning. She has suffered with depression for most of her life, for well over four decades.”I can’t even remember being in places, because I always had a cloud over my head,” she said. “Sometimes one medicine would help a little bit, and then, I wouldn’t go any further than that, it would just flatline.”

On this day, Bates received her fifth out of six Ketamine injections over the course of two weeks.

After the infusion, Lynn Bates looked a little tired. She describes the treatment as a dream-like state, where she journeys into her head, and can walk and work through her feelings and emotions. And right now, she’s feeling good. “Oh my gosh, this is how life is supposed to feel like, that’s how I feel. I want to go out and do things. I want to help other people. It’s been a long road, it really has.”

So, this sounds like a very hopeful story so far, right? But some researchers feel like the use of Ketamine is moving along too quickly.

“What these clinics are doing is essentially experimentation on individual patients,” said Dominic Sisti, a medical ethicist at the University of Pennsylvania. He sees a lot of potential in Ketamine as a treatment for depression – but cautions that doctors simply don’t know enough yet about the long-term impact, and potential health risks.

“If an adverse event were to happen, and a patient would be harmed, that would set back the research efforts that are legitimately happening at research centers, academic centers across the country.”

Steven Levine pushes back on that point – and argues that having this option is far better than having none at all.

“Now we are comparing using this treatment versus having no other options, with severe depression somebody feeling that their back is against the wall with no options, I don’t know that there’s anything more dangerous than that.”

There’s also the cost issue – Ketamine is not typically covered by insurance, an infusion costs several hundred dollars. Sisti says some Ketamine clinics offer questionable financial deals to persuade patients to try the drug.

“You see an offer, ‘get your five infusions and your sixth for free,’ that slants the incentive structure in such a way that individuals who are depressed and feel vulnerable, maybe have concerns, will feel pressure to continue.”

Levine doesn’t offer such financial incentives at his clinic, and says he bills for the visit in such a way that most patients end up getting their treatments mostly covered by their insurance plans. He also directs patients to a website created by patients and advocates which rates Ketamine clinics.

Sisti recommends that people should participate in Ketamine studies at major research universities, rather than going to outpatient clinics.

For Lynn Bates – her initial round of six infusions is over. She said she noticed a dip in her mood about three weeks after her last injection. For now she’ll receive maintenance infusions about once a month.

The effects of Ketamine are not long-lasting – and Steven Levine says he’s trying to optimize the treatment schedule for each patient so that they receive just the right amount to keep their depression at bay.