The Ketamine Question: To Do or Not to Do
In 2010, my roommate was drugged with ketamine by a stranger on our college campus. I found her laying quietly, crunched in a ball against the toilet in the bathroom across the hall from our room. The drug had violent effects on her; I called 9-1-1 and held her limp body in my arms until they arrived. That night, we sat in the hospital until the early hours of the morning, hoping she would be okay, but knowing little about what had gone wrong. Finally, doctors came out to tell us the real cause of what looked to be an extreme case of alcohol poisoning: nearly-lethal levels of ketamine, a club drug originally used in horse tranquilizers. That night, Tyler had bought a Propel water from a man selling bottled drinks on campus, and within minutes, became nearly comatose. Fifteen other girls were also in the emergency room that night because of the same man.
I’ve read about the ‘ketamine craze’ and about recent studies seeking to prove its effectiveness in managing symptoms of depression. Immediately, I think back to my experience freshman year. I think about the implications of the drug, after having seen what an overdose can do to a person of similar size to me. Recently, at the 2017 National Conference for the National Alliance on Mental Illness (NAMI), I attended a panel on the use of ketamine to treat depression. I looked at chart after chart comparing the effects of traditional antidepressants to those of ketamine. Most striking was the immediate nature of relief those on ketamine experienced. I was awestruck and began to consider whether ketamine might actually be a legitimate treatment option.
Prior to surgery, many people are put under by anesthesiologists using ketamine. Recreationally, the drug, known as “Special K,” is used in smaller doses to trip and hallucinate. In Asia, it is among the top abused drugs, and long-term use is correlated with bladder toxicity and cognitive problems. But, does it pose danger to those who use it in a controlled environment, and at precise, patient-specific levels? No one knows for certain. The positive effects of ketamine as a mood enhancement drug were discovered accidentally in the 90s. Pharmaceutical companies Johnson & Johnson and Allergan have manufactured drugs that operate, neurologically, in a similar way to ketamine. Ketamine is not currently FDA approved, but the alternatives are in late-stage clinical trials. The biggest issue with mainstream antidepressant use is that a significant proportion of people who take them show no improvement. On ketamine, though, studies have shown that 60-70 percent of those who were previously treatment-resistant respond positively to the drug. It can also significantly reduce suicidal ideology. How it actually works is not completely understood at this time, but researchers agree that it targets different areas of the brain than the standard antidepressant. It kick-starts what’s known as synaptic plasticity – the capacity for the brain to grow and change – far more quickly than antidepressants can.
The drug appears to work rapidly but wear off just as fast, and is a significant out-of-pocket expense. It runs six hundred dollars on average per infusion, and is administered every few weeks. Ketamine is also rarely covered by insurance, and only a select-few private practices oversee the treatments. It is inaccessible to many, though it seems to have compelling results. Also problematic are the practices themselves, which appear to be inconsistent in how they monitor the risks of substance abuse and other detrimental outcomes. Because use of the drug for treatment purposes is such a novel concept, little is known about these effects, and studies which seek to address them are only at early stages. Evidence that ketamine can be addictive is well established, and a new study at Stanford University is testing whether the drug acts like an opioid. Results will likely be released by the end of next year, but in the meantime, users wait and see what happens.
The number of Americans who take antidepressants has risen sharply over the last few years, with about 12% of the population medicated at this time. Suicide currently costs the United States upwards of fifty billion dollars a year. For those who choose to take medication, the suicide rate increases significantly in the first nine days. In fighting for happiness - a basic human right - things sometimes get worse before they get better. Alternatively, on ketamine, the positive effects appear to begin almost immediately. I repeatedly said "no" to medication for many years, but finally caved and made the most important decision of my life. Transitioning into a life on medication was not perfectly smooth, but it was easy relative to the experiences of a number of my friends. I was painfully nauseous for a week or two, and everything felt worse before it began to get better. I am one of many, though, who can truly say that medication saved my life. Meds even brought out a creative side of me that previously lay dormant, as I wasted mental energy in the simple act of survival. Had I been one of the 30 percent of people who are medication-resistant, I can't imagine what it would have been like to have watched as another opportunity for happiness slipped away. I recognize the privilege I have every day now, because for those who are treatment-resistant, it may truly feel as though life will never get better.
There was a time in which I would've killed to have something in my life that would work instantly. But when instant gratification becomes something you’ll take at any cost, this is when you make decisions at the expense of your health. In combination with an utter lack of care for my body or life, ketamine would likely have been a recipe for addiction. But, with each day of hanging on by just a thread, I lost another small piece of myself until there was hardly anything left. I had no hope. When living with mental illness, you can feel like the world is against you. I couldn't live like that anymore, swimming against a tide that only pushed me further out to sea. I was exhausted and would’ve done anything for different circumstances. And so, I now turn to you for your opinion. How do you feel about ketamine and the use of an addictive and potentially-fatal drug to bring immediate relief? I ask with no judgment and complete empathy, as someone who has suffered from mental illness for my entire life. I recognize the bias in my position, as a witness of the adverse effects ketamine can have. Alternatively, we all deserve to find what works.