Inside Field Trip Health’s New York City clinic, the vibe is less doctor’s office, more tranquil spa.
Tucked away on the 11th floor of a nondescript building, you can barely hear the clamor of the busy streets. Instead, this ketamine clinic feels like a zen oasis, dotted with twinkling lights, lush greenery, and comfy meditation cushions.
That vibe is part of what drew Chere Scythes, 51, back on a chilly Thursday night for another ketamine treatment.
“Some of my friends and colleagues had tried ketamine and other types of psychedelic treatments,” Scythes said. “And talking to them, the stories were hard to believe. But they’re people I’ve known for 20 years and they seem like different people. They’ve had a big change.
Scythes said she first sought ketamine therapy last winter when she realized that a series of traumatic events, including her mother’s death from alcohol abuse, a divorce and, most recently, loss of her best friend, they were taking a toll. Over the years, she said, she had tried antidepressants, but they didn’t work for her. Meditation and therapy helped but didn’t do enough.
“After some time off work and meditating a lot, I realized that I just had this deep sadness inside of me and this anxiety in my chest,” she said.
Ketamine is a hallucinogen approved by the Food and Drug Administration for decades as an anesthetic, but it’s also used illegally as a party drug. In recent years, growing research has found that the drug also works for treatment-resistant depression in some people, which led the FDA to approve a version called esketamine, or Spravato, in 2019. It’s an inhaled version that must be administered in a doctor’s office and is approved only for people for whom other treatments have failed.
But in recent years, even before Spravato’s approval, a new industry has emerged: ketamine clinics, which offer the drug off-label as an infusion or injection for a wide variety of mental health issues. “Off-label” use means the drug hasn’t been specifically approved for those conditions.
At Field Trip, a nationwide chain of clinics that has been offering ketamine-assisted psychotherapy for several mental health conditions since 2019, patients are first screened to see if they’re fit for treatment. If so, patients receive ketamine injections while relaxing wearing eye masks as doctors guide them through guided meditation. They also meet with therapists before and after their “trips”.
“Patients say, ‘This changed my life,'” said Mike Dow, a psychotherapist at a Field Trip clinic in Los Angeles.
It’s not clear how exactly ketamine works in the brain. Dow said he believes it may increase feel-good chemicals, similar to traditional antidepressants, as well as reduce inflammation and train new neural pathways associated with the ability to form new habits and behaviors.
People also undergo psychedelic experiences that can feel spiritual, which in itself can improve their mood, Dow said.
But as the number of new ketamine clinics skyrockets, with centers popping up across the country, some doctors fear it’s an unregulated industry that’s primed for danger.
Since the drug has FDA approval, any doctor can prescribe it off-label. The clinics are not federally regulated, but are subject to the same state laws as other outpatient medical clinics.
“The concern with the emergence of these clinics is that people are receiving treatments that haven’t been well-tried, well-studied, or don’t follow any guidelines,” said Dr. Smita Das, an associate professor at Stanford University School of Medicine and president of the American Psychiatric Association’s Council on Addiction Psychiatry. “My concern is that people who need treatment are spending their money and energy on these ketamine clinics that aren’t well-proven.”
The treatments can be expensive — averaging $400 to $800 per session, said Kathryn Walker, CEO of Revitalist, a chain of clinics that offers ketamine infusions — and aren’t covered by insurance.
There can also be side effects, including changes in mood and blood pressure, as well as nausea and drowsiness.
Das and Dow say they are also concerned that some clinics might offer the drug without any supervision, which is especially concerning if a patient is having a “bad trip.”
Only a few small studies have looked at its benefits for other mental health conditions besides treatment-resistant depression, and the American Psychiatric Association doesn’t provide specific guidelines for its use.
“People may rarely experience paranoia or suicidal ideation,” Das said. “And so many of these clinics don’t have mental health professionals working them. When those mental health issues surface, they may not be equipped to respond appropriately.
Ketamine is also not a panacea. Not everyone responds to treatment, and it can stop working in some people, said Dr. Subhdeep Virk, director of the treatment-resistant depression program at Ohio State University Wexner Medical Center.
“It’s very difficult to predict who will respond and how long it will last,” said Virk, who has been treating patients with ketamine since 2018. He added that it’s unclear whether the drug could help conditions other than treatment-resistant depression. .
Lynette Ebberts, 66, said ketamine was a lifeline for her. For nearly 40 years, she said, she’s tried dozens of combinations of antidepressants, electroconvulsive therapy and other treatments for her severe depression, but nothing has worked.
In 2016, before most people had heard of ketamine for depression, her therapist recommended a clinic near where she lived in Raleigh, North Carolina.
“I said, ‘Yeah, when and where?'” she said. “I was so desperate to feel better. I figured trying something was better than feeling nothing and ending up taking his own life.
Ebberts said each 45-minute brew felt like a dream, in which she saw vibrant colors and shapes. After undergoing three treatments in one week, he said, something started to change.
“I started feeling like I could get out of bed,” she said. “That deep, depressive cloud has started to lift.”
Combined with her antidepressants, she has continued the ketamine treatments and now gets one every five weeks.
Unlike Ebberts, Scythes does not return to the clinic regularly.
She vividly remembers her first treatment. She saw herself as a child, playing in the woods she loved as a child, and then she saw her mother, who died nearly 20 years ago.
“I told her how much I loved her and how much I missed her, and I felt this unconditional love for her that I couldn’t feel when she was alive,” she said. “Once I finished, that deep sadness that had been in my body for so long was just gone.”
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