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The first time I was offered ketamine was at a club in Philadelphia called Milkbar.
My friend knew the owner who was telling us how he came up with the name, which was a lie because any film lover would know he stole Milkbar from A Clockwork Orange. As the lying club owner is regaling us with his bar-naming brilliance, a man came up and asked if we wanted some “Special K”.
Before I could blurt out “Why would we want cereal?”, two people were enthusiastically nodding and little baggies and money were discreetly changing hands. I pulled one of my more drug-knowledgeable friends, who was preparing to snort whatever “Special K” was in a dark corner, and asked him what it was.
He told me it was a horse tranquilizer, kind of like cat Xanax, and you “Lose yourself and trip your balls off.”
“That sounds scary,” I replied. He said it was fun and I took his word for it because I had no desire to “Trip my balls off.”
But he was wrong about it being a horse tranquilizer or cat Xanax. In fact, it’s a common myth that it’s used to sedate horses — ketamine is used in veterinary practices as an anesthetic for many animals, just like anesthesia is used for people.
Ketamine, a hallucinogen, is used recreationally (illegally) to fall into a “K-hole” because it has dissociative and hallucinogenic effects.
It’s not just for animals and K-holes anymore — Ketamine is becoming more widely used for the treatment of depression and other mental health treatments, and for pain relief after plastic surgery.
Take a trip (lol) with us as we explore the drug’s resurgence and its uses in modern medicine.
What Is Ketamine?
WebMD says “Ketamine got its start in Belgium in the 1960s as an anesthesia medicine for animals. The FDA approved it as an anesthetic for people in 1970.
“It was used in treating injured soldiers on the battlefields in the Vietnam War. Unlike other anesthetics, ketamine doesn’t slow breathing or heart rate, so patients don’t need to be on a ventilator to receive it.”
Ketamine activates what doctors call a “dissociative experience” and what anyone else would call a “trip.” Ultimately that “trip” is why it turned into a recreational drug.
“Ketamine can produce feelings of unreality; visual and sensory distortions; a distorted feeling about one’s body; temporary unusual thoughts and beliefs; and a euphoria or a buzz,” says John Krystal, MD, chief of psychiatry at Yale-New Haven Hospital and Yale School of Medicine in Connecticut, where he is a leader in studying ketamine’s antidepressant effects.
“The FDA recently approved esketamine, a derivative of ketamine, for use in a prescription nasal spray to treat severe depression. Ketamine clinics that provide infusions and lozenge-style doses for some cases of treatment-resistant mental illness, like depression and PTSD, are popping up all over the U.S., and studies are now suggesting it can even lead to less opioid dependence in post-op patients.”
Ketamine After Plastic Surgery
It’s also being used in operating and recovery rooms after plastic surgeries, specifically, rhinoplasties (nose jobs).
According to a recent study, “Ketamine is highly effective in reducing agitation post-rhinoplasty.”
Dan Ellis, MD, assistant professor of anesthesia at Massachusetts General Hospital, tells Allure, “When we wake patients up after rhinoplasty with their nose in a cast, nobody likes that feeling.” Ellis explains that “Patients may try to remove their bandages or accidentally knock equipment off-kilter as they ‘reanimate’ or wake up from sedation.
“You have to find ways to calm them down — either verbally or chemically — and bring them into a state of awareness, and ketamine might be useful for that [in the right] dosage.”
Plastic surgeons say ketamine can also makes breathing easier during face-centralized surgeries.
Receiving Ketamine
Ketamine is used for adults who have not been helped with antidepressant use, have a major depressive disorder, or are suicidal.
“They continue on their antidepressant and receive esketamine at a doctor’s office or in a clinic, where a health care provider watches over them for 2 hours after the dose,” according to WebMD.
“For treatment-resistant depression, patients usually get the nasal spray twice a week for 1 to 4 weeks; then once a week for weeks 5 to 9; and then once every week or 2 after that.”
How It Works
For the estimated 70% of people who use ketamine treatment for a mental health issue, the benefits of ketamine extend after the trip ends. Researchers are continuing to study why the benefits continue after use.
What the research shows, so far, is sufferers won’t have the drug trip that ketamine usually causes, but they claim a noticeable reduction of their depression, beginning a few days after a dose.
According to psychotherapist Katherine S.T. Jackson, LPC, ketamine is a lifeline to people and she supports the use of it for treating mental health issues. “When you suffer from severe depression, even a modicum of relief is desirable,” she tells us. “I have had clients experience dramatic improvement after being prescribed ketamine. To them, it is a miracle drug. It allows them to live again, not just exist.”
Jackson says that one of the more interesting aspects of this medication therapy is that it appears to be effective despite the origins of the depression.
“As a psychotherapist, I am unable to prescribe medications, but I am supportive of any empirically validated method that alleviates suffering. Particularly because once the debilitating aspects of depression are lightened, more in-depth analytical work can be accomplished,” she says.
The brain can behave in assorted ways, depending on how it was at the start. For instance, patients with long-term depression lose some vital connections in their brains — synapses — which allow nerve cells to communicate. Researchers think some of those connections are severed and lost due to depression being so stressful.
Studies show that within 24 hours of the first dose of ketamine, those lost synapses begin to regrow. The more connections they grow, the greater the antidepressant results of ketamine are for them.
Costs and Insurance
As of now, the only ketamine treatment for depression that insurance will cover is the FDA-approved nasal spray Spravato. Because the FDA has not approved IV ketamine infusions for mental health use, most insurance will not pay for it.
Without insurance coverage, one IV infusion costs around $450, which amounts to $3,000 to $4,000 for the prescribed six infusions over 3 weeks. And that doesn’t include booster doses, if and when symptoms return.
Mindbloom Ketamine Therapy
A less expensive option is Mindbloom, an online mental health and wellbeing platform that uses “Guided ketamine therapy for depression and anxiety.”
Founder and CEO Dylan Beynon believes that psychedelic medicine is the way forward for mental illness. Launched in 2019, Mindbloom is the first mental health and wellness platform in the field of psychedelic telemedicine.
“I founded Mindbloom to put a dent in human suffering and create transformational client stories like these. Besides COVID-19, the mental health epidemic is the number one public health crisis in the U.S. This crisis is personal to me — I grew up with serious mental illness in my family, and lost my mother to schizophrenia, addiction, homelessness, and, eventually, overdose,” Beynon tells Forbes.
Beynon thinks that the major reasons the U.S. is losing its battle against the mental health crisis are ineffective therapies and shortage (or absence) of treatment.
“Traditional treatments for depression and anxiety simply aren’t very effective. For example, only 40-47% of people who take conventional SSRI/SNRI antidepressants see improvement of symptoms,” he explains. “These antidepressants also cause side effects in over 50% of patients, including sexual dysfunction, weight gain, and insomnia. Talk therapy has been shown to be even less effective at treating depression than SSRI and SNRI antidepressants.”
Benyon says “Mindbloom is improving outcomes and increasing access by supporting the provision of ketamine therapy through telemedicine. Over 80% of Mindbloom clients achieve significant improvement in symptoms of anxiety or depression symptoms after four sessions, and over 90% report some improvement after just two sessions. Only about 5% of Mindbloom clients report side effects from treatment. These outcomes are significantly better than the 40-47% responsiveness rate and 50% side effect rate for SSRI/SNRI antidepressants.”
Mindbloom Results
The platform reports its results are higher than results for basic ketamine treatments with improvements in 65-70% of patients.
“We attribute the increased efficacy of Mindbloom treatment programs to the combination of medicine with coaching and content in a structured program personalized for each client’s needs.”
By utilizing telemedicine and promoting at-home regimens, Mindbloom has done away with some of the difficulties of going to a doctor’s office, clinic, or other treatment facility — and it costs less.
“There are over 200 providers on Mindbloom’s platform, and the average time to get an appointment with an affiliated psychiatric clinician is only about 11 days. Mindbloom is available to 56% of Americans today, and we expect to increase that number to over 70% by April 2022. And Mindbloom treatments cost $110-$190 per session, in contrast to ketamine infusion clinics which can charge $600-$1200 per session,” Beynon tells Forbes.
Mindbloom doesn’t use IV infusions — their program provides tablets that dissolve under the user’s tongue.
“We have found that this route of administration is optimal for at-home use because it is simple and safe to administer, and provides for a peak experience that lasts for about 30-45 minutes,” explains Dr. Leonardo Vando, Medical Director at Mindbloom. “Sublingual administration is similar to intravenous (IV) ketamine in that it produces its main effects by direct absorption and diffusion across the blood-brain barrier, while bypassing liver breakdown. However, sublingual tablets are easier to administer than IV, and they avoid some of the risks associated with IV administration. We have found that this route of administration is optimal for at-home use because it is simple and safe to administer with appropriate guidance and support.”
“Of course, there is no quick fix to any mental health issue,” says Jackson. “But the expansion of access to medication like ketamine, along with talk therapy, will provide great and long-lasting relief for millions.”
What do you think of Mindbloom’s ketamine therapy program? Tell us in the comments!
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