I’m traveling nearly all day today to visit my doctor for a ketamine infusion, as I’ve been doing approximately every 3-5 weeks. I don’t look forward to doing this, so I tend to procrastinate on making the appointment and feel a bit anxious the night before, just as I would with an appointment for dental work or a mammogram. But I continue doing it because it has helped keep my feet on the ground (rather than in a depression hole) for most of a year, something no other previous treatments were able to accomplish. When weighed against the risk of falling back in that hole, the risks associated with this peculiar and poorly understood treatment are a reasonable trade-off in my case. If I had a less serious depression that could be reasonably managed any other way, the cost-benefit ratio would be much different and I wouldn’t be doing this.
I certainly don’t do this because I want to. The treatment sessions were interesting at first because they feel so different from anything I’ve experienced in waking life and I’m a generally curious person, but I have no desire to keep repeating them. If there were a way to get the benefits of this treatment without the hour of dissociation I would absolutely choose that. It would be so awesome if a ketamine metabolite (or something similar) could be developed as an antidepressant with the same benefits and lack of daily-life side effects as monthly IV ketamine – but with no trippy infusion, no needles, fewer risks, no traveling, lower expense, and no drug-abuse stigma. But at this point in time, empirically supported alternatives like this are not available.
Now, just in case you are one of those people who is going to try to tell me that taking much smaller doses of oral or intranasal ketamine at home on a frequent basis is a good alternative to monthly IV ketamine in a doctor’s office, I’m not going to consider that until I see some research evidence on the effectiveness and safety of this approach for treating seriously depressed human patients. At this point in time there is NOT EVEN ONE published study evaluating taking ketamine at home, and my disorder is too severe for me to voluntarily take a chance on a remedy without empirical support. Yes, there is one study to support doctor-administered intranasal ketamine, so I do have the option of traveling all day to dissociate on that every month in a different doctor’s office. But why? The IV treatment is working, and I have no good reason to switch. I’m certainly not going to switch just to avoid having random strangers label me as a self-destructive drug abuser.
The drug abuse stigma many people seem to attach to my depression treatment is hurtful and to the best of my knowledge, unsubstantiated. Yes, there will be irresponsible clinics administering IV ketamine more readily than they should and some patients will end up abusing it — but that risk also occurs with many other medications (including anxiolytics, stimulants, sleeping pills, and the currently available forms of oral/intranasal ketamine). If you are one of those people who is going to feel compelled to tell me that IV ketamine poses a uniquely unacceptable and stupid addiction/abuse risk, I’m going to need you to cite empirical sources to explain how this risk (a) is worse than with the many addictive medications patients can use unsupervised at home, and (b) outweighs the benefits of the treatment.
Some of the scary claims being made about the addiction risk of IV ketamine treatment — in unmoderated discussion forums and in obnoxious comments that people have unsuccessfully tried to get posted on my blog — could easily be the basis for an updated ketamine-centered version of the 1936 movie Reefer Madness, with subplots that sound like paranoid conspiracy theories. Even when the people making these claims are doing it out of a desire to protect the public from harm, their Ketamine Madness story overlooks how harmful depression can be without effective treatment. It also overlooks how harmful it can be to stigmatize others for their health conditions and healthcare needs.
Stigmatizing IV ketamine is likely to prevent depressed and suicidal patients who have run out of other treatment options from getting potentially life-saving help. And if mental health professionals share these stigmatizing attitudes, they’ll be pushing some of their most desperate patients to take the underground route of seeking the medication from a sleazy clinic with inadequate psychiatric care and frightening consequences. For many of us with severe, treatment-resistant depression, IV ketamine may be the last or best available option we have while waiting for research to develop better solutions. We need doctors who are open to working with us and to helping us make safe, reasonable decisions about ketamine. We need the support of our families, friends, and other communities when we pursue treatment. Stigma is probably the last thing that we need.