LAST year, to much ado in the press, Prince Harry wrote candidly in his memoir Spare about taking ketamine to help him deal with his mother鈥檚 death. He isn鈥檛 the only one talking about the substance, which has previously been known mainly as a horse tranquilliser and a psychedelic rave drug. It is hard to keep track of the many celebrities speaking openly about taking ketamine in an effort to improve their mental health.
Across the US, hundreds of clinics have opened to provide intravenous infusions of the drug in a therapeutic setting, a trend that has now reached the UK too. Trailblazing firms, worried about their employees鈥� mental health, are starting to offer this therapy as a benefit. One even floated the idea of installing a ketamine clinic at its corporate headquarters. Meanwhile, pharmaceutical companies are developing over-the-counter ketamine products such as lozenges and topical creams. The drug has become the most commonly available psychedelic therapy.
That might sound like good news given the mounting evidence that ketamine can treat depression, post-traumatic stress disorder and addiction. Yet its use in treating mental health conditions is still novel and many uncertainties remain. Illegal use is rising too, perhaps influenced by its popularity as a therapeutic.
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All this means it is time to ask whether ketamine really can soothe mental health problems, how it works and whether there are any risks to its new popularity. Psychiatrist at the University of Oxford says he works everyday with people for whom ketamine is undoubtedly beneficial. 鈥淏ut it鈥檚 a very bad idea for people to try and treat themselves,鈥� he says.
Ketamine has always been a tricky chemical to categorise. First , early trials in humans noted that high doses of ketamine knocked people out, but lower doses induced psychedelic effects. Over the following decades, it was embraced by both medics and ravers. After being approved as an anaesthetic by the US Food and Drugs Administration (FDA) in 1970, ketamine was widely , and is still routinely used as an anaesthetic in operating theatres. At clubs and after parties, meanwhile, lines of ketamine are snorted recreationally to produce a euphoric, dream-like state often coupled with hallucinations, out-of-body sensations and sometimes complete sensory detachment.
Ketamine infusion
Researchers first noticed the potential mental health benefits of ketamine in the 1990s 鈥� as an unexpected side effect in a study that used the drug to . This was followed by small clinical trials that found people鈥檚 when they were given ketamine via an intravenous drip. Unlike other psychedelics, ketamine has long been licensed as a medical anaesthetic by the World Health Organization, alongside many national health agencies. This means it can often be legally used 鈥渙ff label鈥�, paving the way for the first ketamine clinics, which opened in the US in the early 2010s.
Today, hundreds of private ketamine clinics operate across the US, offering intravenous drips that typically cost hundreds or thousands of dollars each. As of 2022, Ketamine Wellness Centers, then the largest clinic chain in the US, announced it had delivered 100,000 treatments. There are also a handful of private clinics in the UK.
Advocates of ketamine therapy point to a growing mental health crisis. Around 970 million people are . One common treatment is cognitive behavioural therapy, which teaches coping skills. But it isn鈥檛 a cure-all. Meanwhile, treatments for depression specifically, which include SSRI drugs such as fluoxetine (Prozac) and electroconvulsive therapy, can have unwanted side effects. What鈥檚 more, their efficacy is increasingly being questioned. Around one-third of individuals with major depressive disorder and the majority of people with alcohol dependence .
Ketamine is just one among many psychedelic therapies on which hope has been pinned in recent years. Promising clinical trials with substances including , and (the active compound in magic mushrooms) have spurred talk of a psychedelic renaissance. And with many decades of research and medical use behind ketamine, there is a clearer understanding of its benefits and risks over those of other options. As a relatively fast-acting psychedelic 鈥� with a trip typically lasting 30 minutes to an hour 鈥� ketamine also fits easily into a clinical setting. Other psychedelic therapies, which can last for many hours, require people to be closely monitored to reduce the risk of a 鈥渂ad trip鈥�.
The boom in ketamine clinics may be laying the groundwork for other psychedelic therapies to be made legal. Last July, for instance, Australia became the first country to legalise MDMA and psilocybin for therapeutic use. Yet the addictive nature of ketamine and associated risks mean that many experts don鈥檛 regard it as the best option for psychedelic therapy. 鈥淚t can lead to bladder damage and cognitive impairment when abused,鈥� says McShane. All of which poses questions about whether ketamine therapy should be more widely adopted, and how this might be done.
Part of the problem is that we still don鈥檛 have a clear picture of how ketamine therapy works. Broadly speaking, psychedelics are thought to increase neuroplasticity 鈥� our brain鈥檚 ability to remodel itself 鈥� allowing people to reconfigure potentially harmful mental ruts. Ketamine, for instance, promotes the that convey electrical signals. This, quite literally, provides a new network of possibilities and presents new ways of thinking about old problems.
Opinions differ on whether having a trip is essential to spurring these brain changes. It might be that ketamine acts on a molecular level and the psychedelic experience is a transient side effect. Nevertheless, some experts say the trip is crucial if ketamine is to have a profound effect. 鈥淚t鈥檚 within this experience where people have these incredible spontaneous recoveries of childhood memories and pivotal trauma that could be interpreted in a therapeutic context,鈥� says at the University of Exeter, UK. The experience is often emphasised at ketamine clinics, too, which can be more akin to a spa than a hospital ward 鈥� featuring calming decor, weighted blankets and the occasional gong bath.
Part of the confusion around whether the trip is needed lies in finding quantifiable ways to measure psychedelic experience. Currently, a muddle of 鈥渄issociation scores鈥� based on post-trip questionnaires are used, which are often in disagreement, says at the University of Oxford. By using an electroencephalogram headset to observe the brainwaves of people given ketamine, Fabu拧 is developing a more precise benchmark for the intensity of the experience. Unusually, unpublished research has shown that taking ketamine increases gamma wave activity in the brain and decreases delta wave activity 鈥� respectively resembling the brain states of people who have taken psychedelics and those of people under anaesthetic. 鈥淜etamine sits in this weird in-between,鈥� he says.
Ketamine therapy
Whatever the mechanism, ketamine has shown some remarkable results in recent large-scale clinical trials, proving to be an effective treatment for , addiction and . Bookending ketamine infusions with talking therapy can boost and extend the effectiveness of treatment further. In a recent trial of ketamine assisted therapy (KAT) for alcohol addiction, Morgan and her colleagues found that if given ketamine with psychotherapy compared with ketamine alone. 鈥淧atients feel like an active agent in their recovery,鈥� says Morgan. 鈥淚t鈥檚 a really exciting paradigm shift that brings psychology and psychiatry closer together.鈥�
The corporate world is taking note of these trends, too. Since 2022, the US-based natural soap company Dr. Bronner鈥檚 has offered its employees medical coverage for KAT via the heath insurance provider Enthea. Seven per cent of people with this coverage underwent KAT in 2022 as a treatment for depression, PTSD and anxiety. Enthea, meanwhile, says that 12 US firms are offering KAT to 2000 employees in total. One company even floated the idea of bringing ketamine clinics in-house, says Enthea鈥檚 CEO, Sherry Rais.
Corporate sanctioning of ketamine has justified its use to some employees, who were previously wary of the drug鈥檚 reputation. 鈥淲e鈥檙e getting over quite a huge stigma with ketamine therapy,鈥� says Rais. 鈥淧eople have said that they wouldn鈥檛 have tried [KAT] because they didn鈥檛 trust it was a valid treatment,鈥� but their company validated it for them.
Ketamine telemedicine
Amid the shift, pharmaceutical companies spied an opportunity to develop new ways to administer ketamine. Nasal sprays and ketamine lozenges to treat depression are now available, as is a . These formulations are designed to be self-administered at home, used daily or even more frequently. In the US, unsupervised methods like this are being offered via telemedicine 鈥� a service that provides healthcare online or over the phone without the need for an in-person doctor appointment.
The easy availability of at-home ketamine treatments concerns McShane. 鈥淪elf-medicating or recreational patients use higher doses than they would have administered in a clinical setting, and they use it more frequently,鈥� he says. Bolstering McShane鈥檚 concerns, found that more than half of those who tried at-home ketamine therapy reported accidentally or purposefully using more than the recommended dose. The side effects of ketamine are only minimal when it is used occasionally, says Henry Fisher at Clerkenwell Health, a private company that specialises in psychedelic clinical trials. 鈥淜etamine isn鈥檛 meant to be something that鈥檚 administered every day, every week or even every month for years,鈥� he says. 鈥淭hat鈥檚 where we鈥檙e headed. There鈥檚 a commercial model that incentivises companies to move in that direction.鈥�
Illicit ketamine use has spiked in recent years, too, although its relationship to the expansion of therapeutic ketamine use remains unclear. In 2022 in the US, for instance, compared with 2017.
This is cause for concern given the well-established potential for ketamine abuse. 鈥淐ompared to something like psilocybin, for example, it鈥檚 more likely to be habit forming,鈥� says Fabu拧. In October, the FDA about the possible harms of accessing ketamine via telemedicine and emphasised that ketamine isn鈥檛 FDA-approved for the treatment of any psychiatric condition.
The death of Friends actor Matthew Perry, who was found unresponsive in a hot tub at his home in October is a concerning example. Ketamine was listed as the primary cause of death on his autopsy report. Perry was receiving KAT for anxiety and depression but, given the time of death, it was unlikely the quantities found in his bloodstream came from a clinic, .
Ketamine probably isn鈥檛 the best option when it comes to psychedelic therapies, says Fisher, rather it is the most convenient. 鈥淭here鈥檚 been a lot of hype, but it might not be for everyone and the effects might not be long-lasting.鈥� Despite this, the infrastructure being built around KAT remains a useful precursor for rolling out other psychedelic-assisted therapies, he says. Ketamine therapy is unlikely to jeopardise the adoption of psychedelic therapies more broadly, says Morgan, and more to the point, it is already available. 鈥淜etamine can be used right now, with no regulation changes required,鈥� she says. 鈥淭his is really valuable and, given the current mental health crisis the world is faced with, very much needed.鈥�
Consult your doctor before changing your treatment plan.
Ruby Deevoy is a cannabis and聽psychedelics journalist based聽in聽the UK
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