Ketamine for depression

June 8, 2023

Ketamine works for refractory depression

Many with depression get substantial relief from medications or talk therapy, and many simply get better over time. However, treatment-resistant depression leads to terrible disruption for patients and their families, and high rates of disability and suicide. Electroconvulsive therapy (electric shock therapy, or ECT) can be life-changing for about half of those treated. The New England Journal reported last week on a randomized trial of 403 patients that demonstrated that ketamine, an anesthetic medication administered intravenously, was just as effective as ECT.  This is great news, as we certainly need better therapeutic choices for this very ill population.

Ketamine is inexpensive and available generically, but ketamine therapy is not approved by the Food and Drug Administration (FDA) for depression, requires twice weekly intravenous injections for three weeks and extensive observation. Ketamine treatment for refractory depression is often not covered by insurance. A related drug, esketamine, is FDA approved and administered via the nose. This drug is expensive, and also requires extensive observation, so even those with insurance coverage often have difficulty finding providers. Two chains of ketamine infusion centers that sought private pay patients recently went out of business, leaving some patients without care in the middle of a therapy cycle.

Implications for employers:

-        The effectiveness of ketamine and esketamine (and potentially psychedelics in the future) is welcome news for depression therapy, where the last big breakthroughs were almost 50 years ago. 

-        Some vendors might offer oral ketamine for home use, but this would mean the drug was administered without professional observation.

-        Employers can check with their carriers on access to effective treatment for severe treatment-resistant depression.

Instead of a long note on Friday, this week I am again spreading my posts through the week. Please let me know whether you’d rather this newsletter as one long note or 3-4 shorter notes.