Medical professionals call it ‘off-label’ prescription when using Ketamine to gain ground on addiction and depression. It may seem counter-intuitive to use an often-abused drug, ketamine, to conquer a mood disorder – or especially treat addiction to other drugs. First, there has to be an understanding of the properties of ketamine to reduce the stigma of the drug and grasp the prescribing environment.
Off-label uses of drugs are uses that are not approved by the Food and Drug Administration (FDA). Ketamine is, by label, an anesthetic developed in the 1960’s. It’s a Schedule III drug approved for hospital use in liquid or powder form. It was created for use in the Vietnam War to operate on or treat injuries on the front line. It acts fast to dull pain.
Shedding the stigma
As a pain-killer it also has veterinary use, but its primary use is to separate the sensation of pain from an injury. It is also known as Ketalar, Ketanest, and Ketaset. It earned its stigma when it became a popular club drug, ‘Special K’ as it was called, because unprescribed doses gave an out-of-body sensation. Illicitly, it’s a hallucinogen similar in structure to PCP. It has a nasty reputation as a date-rape drug.
The take-home is that it has legit medical use on label, and the side effects in italics above spurred innovative docs to look at off-label uses for those suffering from tough-to-manage depression and early drug addiction recovery. David Feifel, professor of psychiatry at the University of California, San Diego, was one of the first clinicians to use ketamine off-label to treat depression at UCDS’s Center for Advanced Treatment of Mood and Anxiety Disorders, which he founded in 2015.
Used effectively – so far – when all else fails
Feifel was quoted in The Lancet Psychiatry: “Currently approved medications for depression all have about the same, very limited efficacy. A large percentage of patients with depression do not get an adequate level of relief from these antidepressants even when they have tried several different ones and even when other drugs known to augment their effects are added to them. The stagnation in current antidepressant medication on the one hand, and the tremendous number of treatment-resistant patients, propelled me to explore truly novel treatments like ketamine.”
Feifel’s success and other field work provided evidence so enticing that the FDA has granted two ketamine-based drugs ‘breakthrough therapy’ status and fast-tracked them to market. Pharma companies’ studies done so far on ketamine have been small, and its availability is so far limited mainly to ketamine clinics and research studies.
Standard antidepressants usually attempt to regulate serotonin or dopamine levels in the brain. Ketamine operates on a different neurochemical balance in the brain. Those newly clean from drug addiction, which includes alcohol, often battle the depression while their bodies’ delicate chemistries get rebalanced.
In a controlled medical environment, ketamine infusions have been shown to alleviate some of the hard-to-describe ‘tension’ that accompanies withdrawal even that far out from the last illicit high. Post-acute withdrawal is common in the first year to 18 months of abstinence. These ‘symptoms of sobriety‘ can be packed with emotional and psychological stressors that pump up the body’s stress hormone, cortisol.
An addict or alcoholic is retraining the brain chemistry and the risk of relapse is high when stress-hormone levels are high. Cortisol levels actually spike during the low-dose ketamine infusion. That would seem like a bad thing, however, that’s short-term and managed in a supervised, clinical environment. According to a 2014 study from the Netherlands published in the journal NeuroImage, “It’s the longer-term changes (from ketamine infusion) in the physiology of brain regions that are important for behavioral and cognitive adaptation” that show promise. And that’s the positive outcome for those early in recovery from addiction as well as those struggling with depression.
Scott Stevens appears as an exclusive to KetamineTherapyUSA. Stevens is author of four alcohol, health, and recovery books and is principal of alcohologist.com. He is a founding influencer of the world’s largest medical portal, healthtap.com.