Ketamine
WHAT IS INTRANASAL KETAMINE?
Esketamine (also known as S-ketamine) is a dissociative hallucinogen. It was originally only used as a general anesthetic. Now, it is also used as an antidepressant for the treatment of major depressive disorder, with the potential to be effective in many other conditions as well. It is sold under the brand names Spravato, Ketanest, among others. Spravato is the form most commonly used in the US. Since there are serious safety concerns, the FDA only allows certain clinics who specially enroll in an ongoing study (REMS program) to administer the treatment. Unfortunately, we are not able to offer this in my private practice. However, we are lucky to have just such a clinic where I work for my day job, and our trainees are luckier still to get experience there.
HALLUCINOGENS - TAKING THE PLUNGE
I am a skeptic by nature. I approach all new treatments, both medications and natural alternatives, with a healthy degree of skepticism until I’ve seen them work enough times to trust them. Initially, the idea of intranasal Ketamine just seemed bizarre to me. A medication used for anesthesia working as an antidepressant? It certainly seemed far-fetched. On another level, after speaking with colleagues, it began to make sense. So many of our patient’s depressive symptoms stem from traumatic experiences and other stressors that they just can’t seem to get away from. A brief, controlled, and monitored dissociative experience, however, might just provide a “break” from being themselves long enough to provide some real relief!
MAKING A TAILORED EXPERIENCE
I was very struck by a story a trainee in our Esketamine clinic told me. A patient there was initially responding very poorly to Esketamine after administration. This can happen in a minority of cases. After all, hallucinogen use is all about “set and setting.” If you had a horrible day, and you’re in a horrible mood, and you take a dissociative drug, it’s likely you’ll have a “bad trip.” However, using guided mindfulness meditation, our trainee was able to actively turn that experience around. With support and encouragement, this patient’s “bad trip” suddenly became a breakthrough. The patient reported improvements with regards to depressive symptoms immediately after the treatment.
THE TAKEAWAY - YOU NEED A GOOD GUIDE
This incredible trainee, Dr. Manuel Herrera, using his knowledge of mindfulness practices to ensure this patient had a good response to Esketamine. It just goes to show - it’s not as simple as using the substance. Ideally, treatments like Esketamine should be administered in a safe and supportive environment with a professional on hand to make sure patients have the best experience possible.
Thanks Dr. Herrera for your incredible work!
By Dr. Sherer
