Depression is a very serious mental health problem. This is both because a major depressive disorder is a serious mental illness and because as many as 30.9% percent of cases are resistant to treatment. A study published in Psychiatrist states that the yearly national economic burden of treatment resistant depression in the USA is $56.8 billion broken down into $25.8 billion for health care costs, $8.7 billion for the cost of unemployment, and $9.3 billion for the cost of reduced productivity. A bright light in this darkness is a recent study from Australia using generic ketamine to successfully treat resistant depression.
What Is Ketamine?
Ketamine is a synthetic compound first produced in 1962. It was approved as an anesthetic in 1970 and is used in both humans and animals. Anesthesiologists use it because it has much less of a suppressive effect on breathing and heart function than other anesthetics. In fact, in the doses used for anesthesia it stimulates the circulatory system and preserves protective airway reflexes so that sometimes intubation or other protective airway measures are not needed during a surgical procedure. It produces a dissociative anesthesia or trance-like state, relief of pain, amnesia, and sedation. It also produces hallucinations at less-than-anesthetic doses. Thus it is also a psychedelic medicine that has been found useful for depression.
Ketamine Nasal Spray for Depression
An isomer of ketamine is used as a nasal spray for treatment resistant depression. This compound is like a reverse image of the compound’s structure. Intravenous ketamine has been shown to quickly improve depression but the effect only lasts hours to days. Because the effects of ketamine do not last (unlike psilocybin or MDMA), they need to be taken over a period of time. One issue in this case is the expense of the treatment regime. That issue was addressed by a study from Australia.
Double Blind Study of Ketamine for Depression
Australia has recently approved both psilocybin and MDMA for use for the treatment of both resistant depression and PTSD. Their research into the use of ketamine for treatment resistant depression could lead the way to its approval as well. The researchers used a low-cost version of ketamine in a study in which recipients received either the medicine or a placebo. All recipients were individuals for whom standard therapies for depression had not worked.
Affordable Psychedelic Therapy for Depression
Something we mentioned in our article about psychedelic treatment with psilocybin or MDMA is that the total cost of therapy will likely run in the $25,000 range. The bulk of this will be the costs of psychotherapy or coaching. While treatment with ketamine will not require coaching or psychotherapy, the drug itself is expensive. By using a less expensive generic form of the drug the researched were able to reduce the cost. They also give the drug subcutaneously instead of intravenously. This is also simpler and cheaper. The cost reduction was substantial as the usual cost of S-ketamine is about $800 per dose while the generic ketamine cost as little as $5 a dose. Because the injection of ketamine was always supervised the projected cost per injection still ran to about $350 each time or $700 a week and $2,800 for a month. However, this is still substantially less than $25,000!
Who Would Benefit from Treatment with Ketamine?
Even with the sort of approach tested by the folks in Australia, treatment of depression with ketamine (or psilocybin) will be expensive. Anyone who can take a standard antidepressant that costs ten dollars a month and get better will go that route. Although people may well do much better much quicker with a series of ketamine shots, practical economic considerations will lead insurers as well as most physicians to use an approach that works for most people and is cost effective. Treatment with psilocybin or ketamine will in all likelihood be reserved for the sort of folks in the Australian study, people who failed courses of other treatment including the “gold standard” electroshock therapy. Anyone with the money to afford psilocybin or ketamine therapy will in all likelihood opt for any therapy except electroshock treatment, however. As a practical matter we will need to wait and see how this works out as psilocybin and eventually ketamine become part of the standard treatment range of options for major depression.