Pennsylvania

The Off-Label Use of Ketamine for Depression Raises Concerns

Anti-depressants work for only about half the people taking them. The unlucky half quickly run out of options. Some psychiatrists are exploring the off-label use of the common anesthesia drug Ketamine, which has shown results, but is also raising concerns.

Researchers aren't quite sure why or how Ketamine works for people with depression - but several studies have shown that it does, quite dramatically.

Lynn Bates of Sanatoga, Montgomery County, has benefitted from Ketamine. She has suffered with depression for most of her life, well over four decades. No treatment ever helped her — until she started the infusions.

"Oh my gosh, this is how life is supposed to feel like, that's how I feel," she said after a recent treatment. "It's been a long road, it really has."

Bates gets the infusions from Princeton psychiatrist Steven Levine, who started offering them a few years ago.

Levine said he got interested in Ketamine after reading research on its impact on severe depression. He says people who suffer with this condition are usually excluded from all research studies, because they don't respond to treatments.

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"So here's this population that never gets studied," he said. "Everybody would expect they would not respond to something, and they are responding dramatically, at high rates very, very quickly, that caught my attention."

Levine says the drug is safe in the doses he uses and offers hope to patients who have exhausted all other treatment possibilities:

"Now we are comparing using this treatment versus having no other options, with severe depression somebody feeling that their back is against the wall with no options, I don't know that there's anything more dangerous than that."

Levine says he'd like to see research on how to make Ketamine's its effects more long-lasting. Right now, patients at his practice get six injections over the course of two weeks, and then maintenance infusions depending on their need. The treatment is not yet covered by insurance, but Levine says most of his patients get reimbursed for a large portion of the treatments anyway.

Levine is in close contact with other psychiatrists using Ketamine, but has not published any research on the subject yet.

Some experts caution that ketamine should be studied more before being used widely to treat depression. They worry it might have detrimental long-term effects.

Dominic Sisti, a medical ethics expert at the University of Pennsylvania, recently published a paper titled "Proceed with Caution," reviewing the ethical concerns over using Ketamine.

"We also wonder how often these clinicians follow the standard treatment protocols used in clinical trials or if they determine treatment protocols themselves through trial and error or based on nonclinical research, blurring the line be- tween treatment and ad hoc experimentation," he wrote.

Sisti says he sees a lot of potential in Ketamine as a treatment option, but doesn't want its chances to be ruined by a patient getting hurt by the treatment.
 

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