Rolling stone article, "The Psychedelic Miracle"

Earlier this month Rolling Stone published an article about the clinical use of psychedelics in underground clinics.*  It's an interesting read and delves in the motivations and experiences of a number of medical and allied professionals who opt to provide such agents as MDMA, ayahuasca, or magic mushroms (containing psilocybin) in unregulated settings.  That professionals will take on potential legal risk from practicing with these substances is a testament to their belief that they work, and something that is being gradually backed up by high quality scientific studies.  Several organizations are working on this process to formally medicalize these agents and bring them to legal clinical use, such as Hefter, MAPS, and others (see my resources page for links and more reading).  The available clinical data suggests that the classical hallucinogens such as psilocybin, LSD, and ayahuasca (which contains DMT) may have greater efficacy and duration of effect for depression and processing trauma, but it is hard to say concretely without further clinical trials, several of which are in the process due to the efforts of the above mentioned organizations.  Until that time, it seems that ketamine is the only clinically available (and legal) psychedlic available.  

*As as aside, Rolling Stone labels psychedelics as "miracle", which I am always hesitant to endorse as such.  The clinical trial data thus far shows large effect sizes and a relatively benign side effect profile, though with the caveat that these outcomes are carefully structured and take place in controlled medical settings.  As the article mentions, based on the authors personal account of several illicit psychedelic treatments, there can be significant personal turmoil during the healing and integration process; such treatments are not without their risks, and it is very likely that such treatments will not work for everyone.  There does, however, seem to be a correlation between subjects who achieve a mystical experience and better treatment outcomes, at least with the classical hallucinogens.  So perhaps it is more appropriate to term it "a miraculous experience"?


JAMA Psychiatry, "A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders"

Earlier this month JAMA Psychiatry published a consensus statement on ketamine for mood disorders (such as depression and bipolar depression) jointly written by a number of physicians from prominent academic centers across the United States.  While somewhat conservative in it's interpretation of available data, it is notable that academics who have been historically opposed to the clinical use of ketamine, seem to be gradually coming around and while not concretely endorsing its use, do seem to agree on ketamine being a viable treatment option.  As described in the article, plenty of data exists to support the short-term use of ketamine for depression, but the field is still developing in terms of high quality randomized controlled trials exploring ongoing maintenance treatment.  This is not uncommon in psychiatry--that medication treatments are studied for shorter periods of time--though as the data accumulates in favor of ketamine we will eventually see more such long-term studies.  Until that time, clinical experience, case studies, open label trials, and related treatments (such as maintenance ECT) guide the use of ketamine for maintenance of mood disorders.

YaleNews summary:

JAMA Psychiatry article:

Ketamine for depression (Washington Post article)

Ketamine has received a lot of publicity lately as a novel treatment for depression, and particularly because it seems to work when other treatment options have failed.   As a psychiatrist, it is particularly exciting for me to see a treatment that provides such a large magnitude of change (large effect size), works rapidly (on the order of hours typically), and is generally well tolerated by most folks who receive it.  What the article does not delve into are some of the treatment alternatives.  Ketamine treatments are largely modelled after electroconvulsive therapy (ECT) treatments, where several treatments are given in a burst to get people out of their depression, then followed up by periodic booster treatments.  While ECT has been around for many decades, use of ketamine for psychiatric indications (treatment of psychiatric diagnoses) is relatively new, being about a decade old.  Luckily, we have plenty of safety data from use of much higher doses of ketamine in anaesthesia, and it has proved remarkably safe.  When considering options for treatment resistant depression, many individuals are rightfully worried about the cognitive side effects of ECT such as memory loss and amnesia.  Ketamine, at least in the doses used in clinical treatment, does not seem to have such adverse effects.  While the benefits do appear to exceed the risks currently, it is important to monitor side effects and the growing scientific literature, as there is much remaining to learn about the long term used of ketamine for treatment of depression.  Still, at this point ketamine is an exciting new treatment option for patient and doctors alike.  Readers who are potentially interested in receiving such treatments are invited to browse my page on ketamine here.