On September 26 2018 Scientific American published an article calling out some of the business practices being used by ketamine treatment providers across the country. The article summarized legitimate concerns about the business side of the ketamine while reiterating the promise ketamine shows as a breakthrough treatment for difficult to treat cases of depression.

“This is not snake oil. It’s not something that has to be stamped out,” Lieberman said. “It’s something that has to be reined in.”

PASWFL’s Approach to Ketamine Treatment

Ketamine should be administered by a psychiatrist for the treatment of psychiatric disorders. At PASWFL, Ketamine is often part of a complete treatment plan that incorporates other treatments as well including transcranial magnetic stimulation, theta burst stimulation, and genomic testing. At PASWFL treatments are administered and overseen by a psychiatrist. We also use both the PHQ9 and the DSST evaluations throughout treatment to ensure patients are getting the care they need and are on a healthy trajectory towards healing.

The First Antidepressant Was Discovered by Accident

Ketamine is a new and still off-label treatment for depression. The development and improvement of medical treatments is an inherently iterative process.The National Institute of Health put together “A brief history of the development of antidepressant drugs: from monoamines to glutamate” which highlights the sometimes ‘accidental’ nature of pharmaceutical discovery:

“Much like the discovery of the first antipsychotic drug chlorpromazine, serendipity played an important role in the discovery the first pharmacological treatment for depression. Chemists at Hoffmann-La Roche Ltd USA had developed isonicotinyl hydrazide (isoniazid) for the treatment of tuberculosis and isoniazid proved to be a successful antitubercular compound as the mortality rate of tuberculosis significantly decreased after the drug had been on the market for only one year (). While developing new antitubercular compounds, synthesized isopropyl-isonicotinyl hydrazide (iproniazid), a monoalkyl derivative of isoniazid, which would later serve as a catalyst for pharmacological treatment of MDD. Clinical observations reported marked “side effects” of iproniazid in patients being treated for tuberculosis, which included euphoria, psychostimulation, increased appetite, and improved sleep.”

New Treatments for Depression Often Come with Some Initial Uncertainty and Skepticism

It can be all too easy to view the trajectory of “ketamine treatment” in a tunnel. In fact, understanding how other psychiatric treatments were developed and gradually accepted into regular medical practice can help lend some understanding to what’s taking place with ketamine. For example, Prozac triggered the same wave of concerns back when it was first introduced as there wasn’t (and still isn’t) enough data to understand how Prozac actually works and what its impact on the brain and the mind is:

“Prozac, approved by the US Food and Drug Administration 30 years ago today, on Dec. 29, 1987, marked the first in a wave of widely prescribed antidepressants that built on and capitalized off this theory. No wonder: Taking a drug to tweak the biological chemical imbalances in the brain makes intuitive sense. But depression isn’t caused by a chemical imbalance, we don’t know how Prozac works, and we don’t even know for sure if it’s an effective treatment for the majority of people with depression.”

Dialogue Between Key Players is Important

It’s important to discuss the kind of questions and concerns that Scientific American is voicing in their article. Medical professionals and governing bodies should all work to research and inform the public about ketamine as a treatment for depression. It’s important to clearly communicate that while ketamine remains and off-label treatment for depression, the US Food and Drug Administration, the American Psychiatric Association and the American Medical Association have all stated that ketamine shows promise as a treatment for depression.

Medical Innovation is Usually a Gradual Process

Along with eventual FDA approval will come FDA guidelines for administration that will clear up many of the concerns outlined in the recent Scientific American article. An eventual FDA approval would also re-open the conversation about insurance coverage options as insurance providers get up-to-speed with the latest and greatest treatment options. This is a familiar process that many other medical innovations have passed through.