Having only recently gone through ketamine infusion therapy, I find myself wondering how it is that ketamine is the only psychotropic drug that is gaining any measure of acceptance for treatment of depression and other mental health issues. Is it simply because ketamine is already legal for administration in a controlled medical environment, and usage for depression is therefore simply an “off label” application, which is quite common? Or are there other reasons? It seems to me that there are other drugs that have already shown great promise such as ayahuasca and psilocybin, but since these remain illegal (supposedly having no “legitimate” medical use ), further research has been stymied.
This is a really important question - I think there are a lot of substances (both synthesized compounds as well as natural plant-based substances) that have great promise to help improve mental health, that are not currently available. To my understanding, the issue has been the US government (I am not familiar with other countries) making psychedelics illegal (I’d argue for non-science reasons, mostly for political reasons as far as I understand it) and a resulting stigmatization by the public. So even though things like ayahuasca and psilocybin have been around for a long time, they are not used medically.
Some people have an argument that it’s because they have not been studied long enough and their efficacy/safety profile isn’t well characterized (which is probably true - the FDA keeps us safe - but how can people do research when the government makes it illegal and difficult???). It’s a risk/benefit tradeoff. And to me, depression sucks so much, and TRD sucks so much, that the risk of anything going wrong (if we forget for a moment psilocybin is known to be generally safe) does not outweigh the benefits. Like psychiatrists talk about how the long-term safety of these newer drugs might not be well known and we should definitely learn more about long-term use – but we have to use them since nothing else works and the alternative is worse than anything that might pop up! It’s like using experimental therapies for Covid: might not work, or might not be the safest, but at some point there’s no other choice
I think you’re absolutely right ketamine is the first because it has been used for anesthesia for a long time and was FDA approved in 1970 or something like that. So people can’t really argue that it’s unsafe or bad or anything like that. It’s an interesting issue of how we can best get these promising treatments to people like us. Whether that’s through the medical system or whether it’s better to go through recreational/legalization routes. Or both at the same time. The medical research route definitely gives credibility and confidence to regulators to push towards broader access through legalization
While many good points have been raised here, and I’m the last person to defend the FDA and US drug laws (I’m a big believer in broad legalization anyway), “why ketamine?” is not completely arbitrary. Aside from its long track record as being incredibly safe at subanesthetic doses, I’m not sure it the other drugs mentioned here have shown quite the same response/remission rates demonstrated in ketamine clinical trials and pre-clinical research.
Just from my own experience, and that of running a TRD support group, there is almost no one who has gotten much relief from psychedelics, and definitely not the more long-lasting variety characteristic of ketamine. I’m not denying that they might be effective and even more effective in some depressive subtypes, and have always argued for legalization as well as more research into all psychoactive substances across the board. That can only be a good thing. However, that doesn’t take away from ketamine really being uniquely effective at least for a sizable cohort of TRD patients, and it has really earned its place as a game-changer due its own intrinsic virtues.