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Some Charleston patients see ketamine infusions as the future of psychiatric treatments

Dose of Hope

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Nathan is a chemist.

He's an alcoholic, and two years ago he stopped drinking.

He's working on getting an advanced degree and his family just got a new puppy.

Nathan is in a recovery program, on antidepressants, and, in general, working on himself. Diagnosed with PTSD, anxiety, and depression, Nathan had done all he could to feel better.

But it wasn't enough. Until he started getting ketamine infusions.

"There were still unresolved issues that I couldn't shake," he says. "My doctor suggested ketamine, saying that it could reset what my average mood is."

Nathan, whose name we've changed for privacy, is one of a growing number of Lowcountry residents receiving ketamine infusions to help deal with issues like severe depression, PTSD, anxiety, and chronic pain. A patient at Charleston's Ketamine Infusion Specialists, Nathan says that ketamine has helped reset his mood in a way no other treatment could.

He's not alone.

Since 2016, certified registered nurse anesthetist Mike Donovan has been offering ketamine infusions to hundreds of Lowcountry patients out of a desire to help those struggling with mental illnesses. Donovan heads up Charleston's Ketamine Infusion Specialists, which operates out of several Sweetgrass Plastic Surgery locations throughout the Lowcountry.

"I've had family members say, 'You helped us get our daughter or son back,'" says Donovan of the people he treats. "It's that patient that gets me up in the morning. It's another treatment that everybody should know about. I want it to be exposed and for people to have access."

A brief history

Mike Donovan has been administering ketamine to Lowcountry patients since 2016 - RUTA SMITH
  • Ruta Smith
  • Mike Donovan has been administering ketamine to Lowcountry patients since 2016

In the 1950s, Parke-Davis and Company, a pharmaceutical company based in Detroit, began looking for an "ideal" anaesthetic agent that resulted in a temporary loss of awareness while also acting to relieve pain.

One of the agents the company had been testing was synthesized in 1962 and "produced excellent anaesthesia and was short acting," according to "History of anaesthesia: The ketamine story – past, present and future." Because the agent was a ketone and an amine (two types of organic compounds) it was named ketamine.

The first human administration of ketamine was conducted on volunteer prisoners in Michigan. In initial trials, patients described feelings of "floating in outer space and having no feelings in the limbs." Doctors landed on the term "dissociative anaesthetic" to describe the sensation.

In 1966, Parke-Davis patented ketamine for human and animal use, and it was approved by the Food and Drug Administration in 1970. According to the "History of anaesthesia," ketamine was administered as a field anaesthetic to soldiers during the Vietnam War.

Following its use in Vietnam, ketamine started to be abused as a club drug, with the street name "Special K" — and by 1978 it had taken on a reputation as a drug that could offer psychedelic experiences in books like Journeys into the Bright World and The Scientist.

By 1999, because of widespread abuse, ketamine had been placed among schedule III substances of the U.S. Controlled Substances Act. According to the Drug Enforcement Administration, schedule III drugs have a currently accepted medical use in the U.S. and abuse of the drug may lead to low or moderate physical dependence or high psychological dependence.

Nathan says that he sees life differently after receiving regular ketamine infusions - RUTA SMITH
  • Ruta Smith
  • Nathan says that he sees life differently after receiving regular ketamine infusions

As an anaesthetic, ketamine took a backseat to opioids in the '90s, but has since made a comeback after doctors realized the dangers of opioids, including an increased sensitivity to pain. Today, the U.S. Department of Health and Human Services says that the country is experiencing an "opioid overdose epidemic." Opioids like fentanyl, oxycodone, and methadone are schedule II drugs, which have a "high potential for abuse which may lead to severe psychological or physical dependence."

In the past 20 years, ketamine's usefulness has expanded. Now, in addition to use as an anaesthetic, the drug is used to manage depression and other conditions in clinics around the country, including several in Charleston.

The price of a ketamine infusion varies, but most are around $500. Many clinics recommend a series of six infusions over a two or three week period, with the option to continue treatment or re-visit the clinic several months after the last of the six infusions. Ketamine Infusion Specialists also requires an initial consultation ($99) with Donovan as well as a licensed professional counselor and Sweetgrass Plastic Surgery's medical director.

Each session ($495) at Ketamine Infusion Specialists is about 45 minutes long. Patients sit in an anti-gravity chair (which reduces pressure on the back by elevating the legs) in a darkened room, wearing noise cancelling headphones (with the option to play music), and are checked on periodically by a staff member as they receive their infusion through an IV. The counselor speaks to patients before and after their sessions. The first dose is based on a patient's weight and the dosage is increased based on consultations following the first session.

Even with all precautions in place, ketamine infusions are still an experimental treatment for psychiatric conditions. Because of this, the drug's use for treatment-resistant depression is continually being studied.

According to the Mayo Clinic, "Ketamine is known to have short-term effectiveness for the treatment of nonpsychotic, treatment-resistant unipolar and bipolar major depression. Within hours of receiving treatment, patients who benefit from intravenous (IV) ketamine have experienced onset of clinical antidepressive response lasting on average three to 14 days. Little is known, however, about the antidepressive effects and safety of repeated IV ketamine infusions beyond the acute phase of treatment."

Budgeting for happiness

"I've been on every antidepressant. I've been treated for anxiety, I've been on different classes of medications, SSRIs, supplementing with benzos. As far as chronic pain goes, I've done everything — physical therapy, steroid injections, hydrocodone, acupuncture, anywhere between six-nine ibuprofen a day for back pain."

Amy is another patient of Donovan's. A self-described healthy person, Amy works out, eats right, meditates — like Nathan, she was working on herself before she started ketamine. She, too, knew she needed more.

When she started ketamine infusions with Donovan two years ago, she started to see results that other treatments didn't offer. "I would never describe myself as someone with depression, I don't struggle with suicidal thoughts or staying in bed all day. I've never seen myself as someone with that, but I definitely think I've had a tendency to have a default negative attitude about life," says Amy. "One of the things the ketamine did for me, it completely changed my disposition. After those six initial infusions, I just started feeling this sense of joy and happiness that I don't know if I've ever felt before."

Amy says that ketamine is so important to her that she budgets other aspects of her life so that she can afford the infusions. "Believe me, I've gone back and forth, 'Can I even afford it?'" she says. "Ultimately, it's worth it. I'm not overflowing with money. I'm looking for ways to cut my budget — and this would be one of the last ones I would cut."

Both Nathan and Amy stress that ketamine is one part of how they care for their mental well-being. You have to meet the drug halfway — ketamine cannot cure what ails you if you don't want to be cured.

As Donovan says, "Ketamine is not a magic bullet," adding, "It works very well to get patients unstuck."

The danger of the hype machine

As pleased as Nathan and Amy are with their treatments, some patients don't find the same results.

In 2018, Stat News, a health-oriented website produced by Boston Globe Media, investigated ketamine clinics around the country and found that some clinics were not thoroughly screening patients, did not have a mental health professional on staff, did not work with patients' mental health providers, and were "overhyping" the effectiveness of ketamine.

Patients receiving ketamine infusions are placed in low-stimulation environments for a period of about 45 minutes - RUTA SMITH
  • Ruta Smith
  • Patients receiving ketamine infusions are placed in low-stimulation environments for a period of about 45 minutes

Stat News references a clinic with seven locations in Texas, Pennsylvania, Mississippi, and New York: "'Congratulations on resetting your life!!!' it cheerily tells patients on a form they're handed after an infusion."

A clinic in Texas was said to promise that, "the path of happiness begins with the first session."

Misleading advertising, especially with treatments directed at desperate folks seeking relief from the burden of depression, may seem like a big ethical no-no. Still, it's how some clinics market their services. One Colorado clinic even went so far as to offer a free infusion (after an initial series) specifically during Suicide Prevention Awareness month.

The cost is prohibitive to many patients. Most insurers do not cover ketamine infusions because they have not been approved by the FDA for psychiatric use. Dr. Christina Cusin, co-director of a ketamine clinic at Massachusetts General Hospital and a psychiatry professor at Harvard Medical School told Stat News, "The patients who most need the treatment are the patients who can't afford it."

Patients who need it the most

Last month, the Department of Veterans Affairs approved Spravato, the Johnson & Johnson brand name for esketamine, a ketamine derivative administered as a nasal spray. There have been concerns, from doctors and those at the VA, that the drug was fast-tracked without following the proper procedures usually required by the FDA.

Veterans could very well be the patients Cusin was talking about when she referenced those who need ketamine treatment the most. According to a 2016 VA report, the suicide rate for veterans was 1.5 times greater than for non-vets.

But is esketamine the answer? While the nasal spray is still in the early stages of being introduced to patients, the IV drip has proven successful for some veterans, including another one of Donovan's patient, Brad.

"When I had gotten hurt overseas, the marines put me on Zoloft," says Brad, who spent three months in the Atlanta Shepherd Center, a hospital that focuses on the treatment and rehabilitation of people with spinal cord and brain injuries. "It was a lot of heavy stuff for quite a while. For two years I was on heavy depression meds and didn't communicate with friends and family."

That's when his nurse case manager suggested ketamine, and took him to see Donovan. Echoing other patients, Brad describes the experience as a "reset." "You feel like yourself," says Brad of the instant relief ketamine offers him.

Brad acknowledges that ketamine met him at the right time in his life: "Ketamine is like an antidote. If you don't have the other right stuff in your system, the antidote is pointless. You have to be willing." He talks about some veterans he knows who are still processing their experiences through drugs and drinking, sleepless nights and unhealthy habits. "[For them] I don't think anything is going to help until they come in and say they're ready to do something," he says.

One day, Brad would like to be able to open his own ketamine clinics for veterans. He would even like to place a greater emphasis on the psychological aspect of the treatments, so that after receiving their infusions, patients could talk with someone not just about the ketamine session, but about their lives in general. "I think we're missing an opportunity that would be even more beneficial, it's kind of the missing link," he says.

With the support of veterans, ketamine and esketamine could make waves in the way vets get treatment after their time in service. Just recently, FDA officials writing in the New England Journal of Medicine called esketamine "a novel treatment for a severe and life-threatening condition."

Last year the American Foundation for Suicide Prevention acknowledged the strides in ketamine research as it relates to suicide prevention, awarding Dr. Cheryl McCullumsmith at the University of Cincinnati almost $90,000 for her research on "ketamine as a treatment for people having thoughts of suicide."

Parting shots

"It's a no-brainer," says Nathan of including his ketamine infusions in his health care regimen. "For me there really isn't much else."

After a year-and-a-half of treatments, with his current schedule at an infusion a month, Nathan acknowledges the potency of ketamine in his life. "I've come a long way in two years. It really is night and day," he says. "I don't attribute all my success to ketamine, but it's been an integral part. Acceptance is a big thing. As people, we spend a lot of time worrying and regretting the past. I'm coming to own up to certain things and accept them and move on and try to be a good person."

For Nathan and Amy anyway, Donovan's mission to help others "find some relief" has succeeded as he'd hoped.

Thinking of trying ketamine for yourself? Talking to your doctor is key, as is finding the right ketamine provider for you. Research certainly doesn't hurt either.

If you ask Nathan, though, he's quick to answer: "If you have anxiety or depression and you're tired of living like that, just give it a shot."

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