Ketamine, Psychedelics and Mental Health
by Michael Ho
If ever the Covid-19 pandemic had a salutary effect on health care, it was to shed light on the growing mental health epidemic. According to the World Health Organization, social isolation resulting from Covid-19 triggered a 25 percent increase in depression and anxiety worldwide, and an even greater increase in mental health inquires. Such activity has only added to the estimated 21 percent of adults that experience mental health illness every year. That is equivalent to more than 50 million Americans. Equally concerning, almost one-third of adults with a mental illness do not receive the therapy they need.
The prohibitive expense of in-person therapy has paved the way for less costly drug therapies to become the current mainstay of treatment. But despite their widespread popularity, agents like antidepressants have not been universally effective. Mixed results are a recurrent theme in the antidepressant literature. In a recent head-to-head comparison of 21 antidepressants, the majority of commonly used antidepressants were found to be more effective than placebo. But because the study only included patients followed up for two months of treatment, any lasting benefits were not addressed. In a separate examination of the long-term benefits of antidepressants, chronic use of antidepressants did not improve quality of life after two years.
The psychiatric landscape is opening up to an older group of psychoactive drugs. The first to reappear on the scene was ketamine, FDA-approved for medicinal use in 1970. Ketamine’s hallucinogenic and dissociative properties originally led to a variety of uses in veterinary medicine, as an anesthetic for humans and an analgesic during the Vietnam war. It also became known for recreational abuse.
Today, a plethora of publications support its use for treatment-resistant major depressive disorder, bipolar depression, postpartum depression, anxiety, PTSD and suicidality. A growing body of evidence also favors its use for conditions such as substance abuse disorder, obsessive-compulsive disorder, eating disorders and chronic pain.
The antidepressant effect of ketamine often begins within hours. Because the benefit of a single dose may only last only one or two weeks, a common strategy to extend the effect has been to administer multiple intravenous doses over time. Everyone’s response is different, however, so each person’s plan is usually individualized. The precise mechanism by which ketamine works remains unknown. The big picture is still incomplete in part because the mechanism is likely multifactorial.
To Najla Guthrie, CEO of Wellbeing Digital Sciences and KGK Science, the renewed interest in psychedelics comes as no surprise. “Through the 50s and 60s, some viewed psychedelics as potential wonder drugs for treating a host of mental health conditions,” he says. “But their recreational use by the counterculture led to a moral panic, strict regulations and a setback in R&D. What we are seeing now is the pendulum swinging back now in favor of their therapeutic potential.”
The promise of a new generation of blockbuster psychedelic drugs is fueling a revolution in psychiatry, and industry and investors alike have taken notice. Guthrie notes, “Investors have already pumped in over $1 billion in cumulative assets into psychedelic start-ups in 2020 and 2021 alone.” That amount could double before the end of the decade. “Everyone is betting on the long game, positioning themselves to take advantage of the next wonder whenever it becomes legalized.”
For start-ups like Wellbeing Digital, it means not only keeping a watchful eye on the future, but another on the present in support of medications already approved, like ketamine. According to Guthrie, “The future of psychedelic medicine is intriguing, but what is most important is that we use our current technology to help patients manage their symptoms today—we have ketamine, a drug that has been shown to treat depression, relieve anxiety, improve everyday function and restore quality of life rapidly and with minimal side effects.” For the hundreds of people fortunate enough to find benefit from ketamine, it can be the single most important, life-changing moment of their life.
Dr. Michael Ho is the medical director of Mindscape Ketamine & Infusion Therapy, located at 2211 Norfolk St., Ste. 215, in Houston. For more information, call 346-439-9600 or visit MindscapeKetamine.com.