Ketamine Clinics Hope to ‘Open New Doors’ for Patients with Severe Depression

This story was reprinted with permission from Crain’s Cleveland and written by Paige Bennett.

Austin Hoover’s depression had been weighing him down for years.

Despite treatment and therapy, the Shaker Heights, Ohio, resident continued to struggle.

That’s when his therapist, Dr. Melissa Briggs-Phillips, suggested he try ketamine-assisted psychotherapy, which uses low doses of the dissociative anesthetic to manage mental health conditions like major depression.

Hoover went into the treatment with an open mind, but he was still surprised by the results.

“What was amazing for me was what happened after the infusions,” he said. “There were doors that were stuck for me in therapy, and this allowed me to open some of those doors that were difficult for me to open.”

The treatment helped Hoover lift the floor on his treatment-resistant depression, he said, and stopped the repetitive thoughts that had plagued him for years.

Ketamine has been used as an anesthesia during surgery since the U.S. Food and Drug Administration approved the drug for that purpose in 1970, but in recent years, researchers have been looking into ketamine as a treatment for severe psychiatric disorders. They believe administering the drug in controlled, clinical settings can help those with treatment-resistant depression and other conditions.

“I open doors, I believe, for people to find the things they’ve suppressed or repressed, the things that are holding them back,” said Dr. David Caldwell, anesthesiologist at MiNDSET Integrated Ketamine Care Clinic in Columbus, Ohio. “That can be depression, that can be anxiety, it can be PTSD or suicidal ideation.”

For medical professionals, Ketamine is not a first-option treatment for depression. In general, it is used when other treatments, such as antidepressants, have not been effective. Ketamine treatments are typically delivered by IV infusion or an intranasal spray.

It works by targeting NMDA receptors in the brain, according to Columbia University Irving Medical Center. When the drug binds to these receptors, it appears to increase the amount of glutamate, a neurotransmitter, in the spaces between neurons, which activates another receptor. The combination of these effects results in the result of other molecules along new pathways, a process that likely affects mood, cognition and thought patterns.

A study published earlier this year in “The New England Journal of Medicine” showed that ketamine is at least as effective as electroconvulsive therapy for patients with treatment-resistant major depression without psychosis.

Dr. Brian Barnett, a psychiatrist at Cleveland Clinic Lutheran Hospital, said there has been significant research on the effectiveness of ketamine for treatment-resistant depression over the past 20 years. But recent developments in the area have accelerated interest in recent years.

In 2019, the FDA approved intranasal esketamine, a chemical cousin of ketamine, for treatment-resistant depression. The federal agency, however, has not yet approved ketamine for people with treatment-resistant depression.

Barnett said research has shown ketamine to have rapid antidepressant effects. It has also been shown to help reduce suicidal thoughts. But the effects are short-lived, Barnett said, making ketamine a maintenance treatment for depression.

The Cleveland Clinic usually administers ketamine by IV for patients with chronic pain, Barnett said. Those receiving the treatments for depression will typically receive esketamine, a nasal spray.

Since the FDA approved intranasal esketamine, ketamine clinics have been popping up around the U.S. In Ohio, there are clinics in Middleburg Heights, Toledo, Dayton and the Columbus area.

At MiNDSET, Caldwell reviews a patient’s medical history prior to an infusion. When the patient arrives for treatment, he conducts a brief physical exam of their heart and lungs, then takes them back to an infusion room.

“You get an IV in,” he said. “You’re going to put headphones on, either noise cancellation or some non-vocal music. You’re going to wear an eyeshade that completely blocks out light. We’re going to lean you back, and the infusion is going to begin.”

Caldwell said the infusions create a dissociative experience that generally lasts about 40 minutes. Patients typically wake up 10 to 20 minutes after the infusion is completed. Caldwell checks their vitals.

“It’s pretty amazing how quickly patients get back to baseline,” he said.

Side effects of ketamine can include dissociation, intoxication, sedation, high blood pressure, dizziness, headache, blurred vision, anxiety, nausea and vomiting, according to Harvard Health Publishing.

MiNDSET combines ketamine treatments with psychotherapy. Briggs-Phillips serves as the clinic’s psychologist-in-residence. Patients can meet with her or bring their own therapist to the clinic to work with them following their ketamine experience. The goal is to help patients uncover problems and then process them in therapy.

“Our brain is always firing in new ways,” Briggs-Phillips said. “But when something has happened over and over and over again, it’s like the grooves of a sled going down a hill. Your brain gets in a habit. And in talk therapy, we certainly challenge that … the folks after six infusions of ketamine, it has been remarkable to me what we are able to do, the insight, the resolution, the shift.”

Hoover had six total ketamine infusions, which he finished about a month ago.

Since then, he said he has felt much more in control of his depression.

“I think for people who have treatment-resistant depression, it makes a lot of sense for them to try,” he said. “I’m really excited for more science to be done, because it might help even more than we realize.”

Lynn Nguyen is chief strategy officer for New Pathways, a clinic that offers both ketamine treatments and FDA-approved Spravato nasal spray. The clinic has locations in Middleburg Heights and Columbus.

Nguyen said New Pathways opened in 2021 and has seen steady growth so far.

“There’s been a huge difference in the health care field, for me at least, to see my patients improve so much in such a little amount of time,” she said. “And be able to uncover some of their traumas that they’ve never been able to even think about. It’s almost like a new mindset that they just after these treatments.”

Caldwell said the treatment is especially important because an increasing number of people are suffering from mental health conditions.

A 2021 National Survey on Drug Use and Health found that an estimated 21 million adults in the U.S. had suffered from at least one major depressive episode.

Barnett said there is an extreme access problem with ketamine treatments and that a single treatment may cost anywhere from $500 to $2,000. And because ketamine is not FDA-approved, it’s not covered by insurance.

He also noted controversy in the field over the growth of free-standing clinics because some don’t have the proper mental health background to provide patients with the necessary care.

Caldwell said that cost is a barrier for many who may otherwise be interested in receiving ketamine treatments and that he hopes to make them more accessible in the future.

“My goal is to create a foundation where we can make this accessible to people who are motivated and want to get better, that meet criteria,” he said. “For me, it will be veterans. Veterans, by and large, don’t have the means to afford this care, but they might be one of the most significantly impacted sectors of our population.”

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