Clinic ketamine-assisted psychotherapy results published

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I’m excited to share my recent publication on ketamine-assisted psychotherapy done here in my clinic in Los Angeles. I partnered with a colleague at Stanford university, Boris Heifets, M.D., Ph.D., to help analyze all the data. It follows patients with depression (and often addiction as well) that I’ve treated over a period of up to 6 years, with combination intramuscular ketamine and psychotherapy that I provided, first in the initial phase of six sessions over a month, and then maintenance phase during this time (approximately monthly). As expected, over time people moved or discontinued treatment, but despite attrition we have enough long term data here to get a look at the good and the bad of ketamine over a long period of time. A few findings and thoughts:

  • ketamine assisted psychotherapy works well: around 80% of people respond, in terms of significant and meaningful improvements in depression

  • tolerance wasn’t a consistent finding; i.e. it continued to work well for many, for years

  • it’s mostly safe: nausea, sedation, and dizziness were most common. A minority of people had emesis (threw up) but anti-emetic medications helped.

  • addiction to ketamine is possible, and can be severe: One person with a history of polysubstance abuse went on to develop a ketamine use disorder, using to excess, losing their job, and suffering a number of other problems. This illustrates the intriguing duality of ketamine as a compound that can both treat depression addiction as well as cause it, and makes the case for keeping such ketamine-assisted psychotherapy as an in-office treatment.

Check it out at the links below. I’ve got a link to the paper as well as video talk I gave on it at the University of Oxford, UK, Ketamine international journal club.

psychedelics for addiction

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“The first major impact of a psychedelic experience in the 20th century in relation to addiction was that of Bill Wilson, the founder of Alcoholics Anonymous. He had an atropine-induced revelatory experience that he described as follows: “Suddenly the room lit up with a great white light. I was caught up in an ecstasy which there are no words to describe. It seemed to me in my mind’s eye, that I was on a mountain and that a wind not of air but of spirit was blowing. And then it burst upon me that I was a free man.” Bill’s psychedelic spiritual experience changed his life—through it he felt he was able to escape from the shackles of alcohol dependence, becoming permanently abstinent (for more details on the history of psychedelics, see Nutt, 2023).”
— Nutt et al.

Psychedelics, including more broadly, MDMA and ketamine, along with the classical psychedelics like LSD and psilocybin/psilocin, are being studied more and more as treatments for substance use disorders (ie, addictions). More studies means more data in support of their use, and already we are seeing such clinical trials demonstrating hopeful effects of ketamine on treatmnet of alcohol use disorder, opioid use disorder, cocaine use disorder, and cannabis use disorder. Use in these indications are still being studied, and it’s unclear how ketamine would be marketed given it’s a generic drug and being used off label. The limited data we have on the FDA approved ketamine product (esketamine nasal spray, AKA Spravato), suggests it is less effective than generic racemic ketamine, at least for treatment of depression. It is certainly much more expensive ($600-900 instead of $2-3). It is possible that a company will try to gain FDA approval for one of these indications, but then they would risk clinicians simply using generic ketamine off label, bypassing their formulation, and decreasing their profit potential. It makes me wonder if any company will actually invest in the work to carry out FDA trials for this.

Nutt DJ, Morgan C, Klaire S. A Perspective on Psychedelics as Treatments for Addictions. Journal of Studies on Alcohol and Drugs. 2024. 202485:5,583-588

full text: https://www.jsad.com/doi/full/10.15288/jsad.23-00032