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How ketamine went from dancefloor drug to wonder pill

From afterparty to doctor's surgery: we speak to a New York anesthesiologist who prescribes ket for depression and PTSD

For the past decade or so, ketamine has clung onto its place as a party drug reserved for the dancefloor and/or the afterparty. The powerful general anesthetic causes extreme hallucinations and loss of coordination. Overconsumption is an ugly sight: if you’ve seen someone in a K-hole, you’ll know how gruesome it looks.

Despite its strong union with nightlife, its reputation as a wonder drug for depression and post-traumatic stress disorder (PTSD) is growing stronger all the time. Last year, British scientist Dr Rupert McShane told the BBC: "It really is dramatic for some people, it's the sort of thing really that makes it worth doing psychiatry, it's a really wonderful thing to see. The patients say, 'Ah, this is how I used to think,' and the relatives say, 'We've got x back.'"

Research into ketamine as a PTSD treatment began in the 90s, after soldiers returned from the Gulf War harrowed by the sight and sounds of battle. Veterans who had been given ketamine to treat pain after having limbs blown off had half the rates of post-traumatic stress as soldiers who hadn't. Over in the US, ketamine infusion clinics are now springing up across the country, with 17 currently listed on the Ketamine Advocacy Network

Dr Glen Brooks is a New York-based anesthesiologist who has worked with ketamine since the 70s. His clinic, New York Ketamine Infusions, is situated just off Wall Street. Dr Brooks has treated close to 500 post-traumatic stress patients, using predominantly intravenous methods, as well as pills and nasal sprays. He says that he understands ketamine better than he understands his own children.

"There can be no doubt about it, ketamine works," he told us. At the moment, Dr Brooks sees between eight and 13 people per day. These are patients who have carried trauma with them throughout their lives and are desperate to get rid of it, at an average cost of $450 per session. Some are cured almost immediately, some have been with him for more than two years. We spoke to him about his work and how he started treating people with ketamine. 

What kind of results have you seen from treating patients suffering from depression with ketamine?

Dr Brooks: The patients I treat are really all victims of childhood trauma. Childhood trauma is what leads to the lifelong major depressive disorders. They can all trace their PTSD back to stress, anxiety, pain or some sort of horrific childhood event that morphed into depression by their late teens or early 20s. There are varieties of childhood traumas. It could be something like sexual abuse, incest, physical abuse or abject poverty. Interestingly enough, I see quite a few patients that are victims of bullying in little school or high school. People don’t appreciate the long-term scars that leaves on many people.

The success rate really depends on what age they start treatment. If I get young adults in (25 or under) You can see a success rate of 75-80%. But with geriatric patients in their seventies, it’s probably closer to 25 or 30%. And it’s sort of a sliding scale all the way down. When you talk about success rates it does have quite a lot to do with decades or symptoms.

How did you start working with ketamine?

Dr Brooks: I've been working with ketamine since 1976. I understand ketamine more than I understand my own children. It's an amazing drug, it's an extremely safe drug, it's found in every operating room in the world, every operating room in the UK and every anesthesiologist's room in the UK. That's what ketamine is, it’s a general anesthetic agent. The doses we use to treat depression are really quite small. I've worked with ketamine treating depression for about two and a half years at this point. Previously I was using ketamine to treat certain types of neuropathic pain. However, this is as much a passion as it is a job, the reason being that 15 years ago I lost my 19-year-old son to suicide. After he died, his mum and I did all the usual things that people do. We set up scholarship funds and gave to charity, but I never really recovered from that. Once I realised I could start saving other people’s kids it became all I really wanted to do. 

Is it harder to convince people to use ketamine medicinally because of its reputation as a party drug?

Dr Brooks: It's unfortunate that it's got that reputation. It may be a party drug but then it's certainly not its main purpose, by any means. When it's used as a party drug, they're using doses that are much stronger than general anesthesia doses. People say 'it's Special K' or 'it's a horse tranquilliser'. For cats, it works pretty well. It doesn’t work on horses at all. But this is the kind of nonsense that becomes a part of pop culture when people talk about ketamine.

The thing you have to realise is we're doing this to save lives when nothing else seems to work. These patients have gone through decades of psychotherapy, they've tried 15 or 20 different medications, many of them have had electric pulse therapy. These are people saying, 'I want to die, I can't get out of bed, I can't brush my teeth, I haven't changed the sheets on the bed in two months, there's no food in the house' – these are really sick patients. Ketamine isn't for somebody who's lost their job and had depression for the last six months. Ketamine is really for people who have nothing else left. And we're saving lives, that's really the bottom line. What's the cost of not doing therapy?

How much more effective is ketamine compared to traditional drugs like Prozac? Do you think it's something that should be used more widely?

Dr Brooks: I think that's a difficult question. Not everyone with depression needs ketamine. After my son died, I arrived into a severe depressive state. But it was a situational depression and therapy and drugs like Prozac helped me through it. There's definitely a place for other psychotropic drugs, and there's a place for talk therapy, but again, it depends on the kinds of depression you're talking about. What we deal with is with major depressive disorders. We have pretty honest discussions with patients about what's going on, what got them to this point and what in effect is the best course of treatment for them or whether ketamine is even appropriate. 

“What patients usually describe is ‘the dread leaving’ or they say ‘I feel lighter’. Music sounds better, colours look brighter” – Dr Brooks

Say I come to your clinic suffering from depression. Where do we go from there, how long will a treatment last and when do you decide it's over?

Dr Brooks: We'd begin with two infusions, generally 24 hours apart, to see if in fact ketamine will help you. It's pretty obvious – you know quickly if ketamine's going to work, it's not a long drawn-out deal. The first infusion we do is over 45 minutes and it stays pretty much on an industry standard dose of half a milligram per kilogram. It takes 45 minutes or so. The patient stays for maybe another half an hour and they walk out the door with no residual effects of any kind.

If they're not feeling better by the next morning I bring them back in and we double the dose. We do a full mg per kg. If they're still not feeling better by the next morning, at that point we have a discussion whether it's worth continuing because generally if you don't feel better within 48 hours, they're not going to respond. And I'm really not interested in taking people's money, wasting their time or giving them any false hope. If they do feel better after the first or second infusion I like to do a series of six infusions. Those infusions, depending upon patient preference, would be every day or every other day until completion. After that point, the patients then go into a maintenance programme which consists of coming back to see me when they need single booster infusions. That averages about every six weeks. I also use certain drugs as ketamine extenders in the form of nasal sprays or pills in order to lessen the cost for patients and help keep them depression-free.

What's the quickest response you've had to a treatment?

Dr Brooks: We have the quickest response with patients who are suicidal – sometimes you see results within two or three hours. What patients usually describe is 'the dread leaving' or they say 'I feel lighter'. Music sounds better, colours look brighter, they can get out of bed, brush their teeth, engage with people around them. They start to think about the future and about possibilities.

How many lives do you think you've saved?

Dr Brooks: For the 500 or so patients I've treated, I'd say that 200 were seriously suicidal, many had attempted it before and lived with thoughts of killing themselves day in, day out. As far as I know, they're all still alive. There is a minority of patients who do not respond, for reasons we aren't sure of. I know we've saved lives, there's no doubt about it. What we're doing is important – whether something better comes along is another matter. If it does, I welcome it. As it stands now, intravenous ketamine infusion is the gold standard.