Does ketamine therapy provide a way out of depression?
Ketamine therapy is a new treatment for severe, treatment-resistant depression and associated mental health conditions.
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Jacintha was at the end of her wisdom. Her daughter was struggling and they tried everything – two types of antidepressants, years of talk therapy, and a multi-week intensive outpatient program.
One night, she was desperately Googleing when she came across an article about ketamine therapy. Although jacintha, a horse rider, was well versed in ketamine as a horse tranquilizer, he had never heard it as the ultimate mental health treatment for treatment-resistant patients like Lucy, who was diagnosed with depression, obsessive-compulsive disorder, and post-traumatic stress disorder.
There was only one. Most ketamine users are over 30. Lucy was only 16 years old.
“When people are desperate, you’re ready to take the desperate steps,” says Jacintha, who asked her to withhold her last name to protect her daughter’s medical privacy. “I think a child who is struggling just as hard as Lucy is struggling would want to do it.”
Ketamine therapy has become popular in recent years and, if selected, is used to treat young people. Doctors say they can provide life-saving support if other drugs fail, but there are risks including the possibility of dependency when administered inappropriately. Despite the potential risk, some young users and their families say attempts to treat controversially better than being stuck in the current situation.
Dozens of Reddit commenters have spoken about seeking care for minors, but most USA Today refused to make it on the record for fear of stigma.
“The harmful effects on the brain grown in severe treatment-resistant depression are far worse than the risks associated with very sporadic administration of these low-dose ketamine,” he adds, however, that should be a last resort, as there is little research into the effects of ketamine therapy on younger adults.
How ketamine therapy works in the brain
A few months after a Google search, Jacintha and Lucy proceeded to Bellevue, Ketamine Clinic, northwest Bellevue, Washington. There, Lucy began the first of 12 ketamine infusion sessions managed in December and May 2023.
The doctors were explaining how ketamine infusion works. Chemicals bind to receptors in the brain, disrupting the brain’s connection to the body, leading to a disconnected, in vitro sensation that can cause Lucy to experience separation from reality.
During that first session, Jacintha held Lucy’s hand and was cautiously optimistic. Things got worse before they got better, and Lucy experienced mood swings and random anger. But after the seventh session it seemed like something “a complete shift.”
This therapy helped her manage self-harm and contamination-triggered OCDs. Before ketamine therapy, when she heard someone cough or breathe loudly in the classroom, she went into panic mode and eventually dropped out of school. At home, she never entered the kitchen downstairs. I was overwhelmed by the fridge, dirty dishes and the smell of the food.
After the injection, “I felt better than ever,” says Lucy. “It really changed my mood very much. I generally had a higher level of functionality every day. I was not always depressed.”
Representatives from the Northwest Ketamine Clinic say their clinic does not treat people under the age of 14, but there is growing interest from parents seeking to treat teenagers.
According to Krystal, ketamine works by stimulating the brain’s resilience mechanism. Chemicals target different systems in the brain than standard antidepressants, causing the release of glutamate and stimulate the growth of new synapses between brain cells.
“Brain plasticity – the ability to learn, adapt, and respond – becomes impaired by depression,” says Crystal. “Even a single dose of ketamine can have a positive effect on this type of plasticity, which could lead to psychotherapy and (other) types of interventions.”
Laura Picard, 23, turned to ketamine therapy in search of relief. She has been fighting depression and anxiety since she was 15 years old and cycled medications such as Prozac and Wellbutrin. In 2022, her father died of an overdose, and just 16 months later, her mother died of suicide.
After her mother’s death, she suspended her education at Baylor University and returned to Los Angeles, where she began working with a counselor specializing in losses. She explained that she was wearing glasses for the first time since she was suffering from depression.
“Before ketamine, everything was spent five times more effort on me to do because of depression,” Picard says. “After getting ketamine treatment, I wanted to wake up and do things. I had the energy.”
Since then, Picard has had three maintenance sessions, but she believed she helped her return to school last year to earn her degree.
“I still get the feeling that I was a little too young for it.”
When Crystal began researching ketamine in the 1990s, it was still known as a horse tranquilizer or by the street name Special K. Most notably, drug abuse was associated with the death of Matthew Perry after using ketamine under the care of a doctor to treat depression.
The most common short-term side effects of ketamine therapy are dizziness and nausea, but in extreme cases, the long-term use of ketamine is linked to memory problems, gastrointestinal problems and urinary tract infections, according to the Institute for Substance Abuse.
A 2017 case study from the Yale Children’s Research Center found that within 24 hours of receiving treatment infusion, depressive symptoms in adolescents aged 13 to 17 years of age with treatment-resistant depression, with improvement lasting at least two weeks.
Dr. Ryan Sultan, a psychiatrist specializing in ketamine treatment in integrative psychiatry, said: “The younger the brain, the less it is formed, so there is a higher chance of negative effects.”
Lucy doesn’t regret ketamine therapy, but says it’s a bigger step than she noticed at the time.
“I still get the feeling that I was a little too young for it,” says Lucy.
Krystal said ketamine is most effective in a very narrow dose range. Doubled doses lead to more side effects, but more effectiveness, and halving doses will result in less effectiveness of antidepressants. He has seen examples of misuse that people start using ketamine eight times a day, exacerbating depression.
Lucy and Picard are treated through intravenous (IV) ketamine therapy. This is legal but off-label use of the drug. According to Sultan, the only FDA-approved form of treatment is an esketamine nasal spray known as Spravato, but the majority of ketamine therapy administered is via IV. Neither form is FDA approved for children.
As a result, the field of ketamine therapy is unregulated. Hundreds of independent outpatient ketamine clinics have emerged across the country after the FDA approved escamine in 2019. These clinics may employ a mixture of anesthesiologists, psychiatrists, nurse practitioners and therapists, but quality and safety vary from clinic to clinic.
Insurance rarely covers IV ketamine therapy, and users pay hundreds of pockets per session.
Crystal warns that people who use ketamine for treatment outside of clinics often do it inappropriately. Most of the ketamine distributed in the United States is illegal, according to the Drug Enforcement Bureau.
“Because adolescents are at a higher risk of addiction issues, the concerns I raise about people who have access to ketamine at home is growing even more for youth,” Crystal says.
Jacintha initially worried about introducing her ketamine sensation to Lucy, but she spoke with Lucy about the dangers of seeking that sensation in a clinical setting.
“Do I misrepresent her the euphoria that she might want to continue pursuing in other ways?” Jacinto says. “If she has no access to ketamine and still wants to go back to the feeling that ketamine has given her, will that lead her to other kinds of substance abuse?”
Why is ketamine therapy not a treatment?
Since April 2023, Lucy has been using one maintenance session every six months in combination with talk therapy and antidepressants.
“Even today, I can rely on stress and mood. But I think the biggest reason why OCD is more manageable is because depression is more manageable,” says Lucy.
Still, Jacintha said he hoped they saw greater results, warning that it was not a miraculous cure.
“This is the cannonball we were looking for and we wanted to open and blow all of this out, but it wasn’t,” Jacinto said.
Ultimately, Lucy and Jacintha knew the risks of ketamine therapy. However, they agreed that the side effects would be pale compared to the struggles Lucy was experiencing.
“I chose to give my child ketamine, so if I think I’m a bad parent, I’ll invite you to live and live my life,” says Jacinto. “When you see a child full of such serious mental anguish and drowning every day, you are stuck in hope.
Rachel Hale’s role in covering youth mental health at USA Today is supported by a partnership with Pivotal and Journalism Funding Partners. Funders do not provide editor input.
Contact her at rhale@usatoday.com and @rachelleighhale.
