Ketamine, a drug previously associated with rushing parties, bright lights and loud music, is increasingly being adopted as an alternative treatment for depression for millions of patients who do not get better after trying traditional medications.
The newest treatment provider is Columbia University, one of the largest academic medical centers in the country.
As of this month, Columbia joined a growing list of major medical centers that offered patients with severe depression ketamine infusions for which traditional antidepressants such as Prozac or Celexa have failed.
In other parts of the US, patients may get ketamine in some small clinics, but not all of them are subject to the strict medical supervision normally required of academic medical centers. In some cases, patients may also receive treatment through participation in research studies, but the move to Columbia will help make the treatment more widely available.
Ketamine is not cheap and can not be administered quickly. Because it is an infusion, the process can take anywhere from 45 minutes to two hours. Each session costs $ 500- $ 750 (Columbia charges $ 650) and is not insured, as ketamine is only approved as an anesthetic in the US.
Patients receiving ketamine for depression should typically receive 8 to 1
Despite its high price, ketamine has been referred to as the "most important discovery in half a century" for mental illness. The drug appears to occupy a different part of the brain than traditional antidepressants, and its obvious rapid-fire effects can be particularly useful in suppressing the suicidal thoughts of people who are considering taking their own lives, experts say. Ketamine has also been used for a long time for the prevention of pain, which doctors say is relatively safe.
"Ketamine is the true deal as it is a true pharmacological agent that has long been used for anesthetics," said Jeffrey Lieberman, chairman of the Psychiatric Department of Columbia University's Irving Medical Center and director of the New York State Psychiatric Institute Business Insider.
And while ketamine's applications for mental illness are relatively new, Lieberman hopes the drug will ultimately be more widely available to patients in need.
"The most important discovery in half a century"?
Most antidepressants, from Abilify to Zoloft, work in places where our brain uses serotonin, a chemical messenger that plays an important role in mood. The result is more free-floating serotonin and in some people the relief of depressive symptoms from a dark curtain. But every third patient does not respond to the medication, and since then, no new type of depression medication has been invented.
These are the patients from whom experts say ketamine could help.
These patients may find it helpful to think of depression as a severe pain, said Cristina Cusin, a psychiatrist at Massachusetts General Hospital and assistant professor at Harvard University, this spring. When the pain becomes so intense that it interferes with daily activities – even something as simple as writing an email – patients may feel desperate enough to do anything to relieve the suffering. But antidepressants take 4-6 weeks to work.
That's not good enough for patients who need help now, Cusin said.
Read more: A handful of clinics advocate a "party drug" that could be a rapid onset of depression treatment – we have a look
A growing list of providers offering ketamine  The Ketamine Clinic of Columbia University Medical Center
Large institutions are beginning to use ketamine therapy.
On the west coast of the University of California at San Diego in 2010 began the infusion to select patients with major depression. Kaiser Permanente began administering ketamine to people who had not responded to other medicines in 2015 as part of a pilot program in Northern California.
On the opposite side of the country, a handful of specialty centers have recently offered the treatments. These include Emory University, Yale University, and the Massachusetts General Hospital, which will be offering treatments as of fall.
Several other medical centers, including the Cleveland Clinic, the Mayo Clinic, and the Icahn School of Medicine at Mount Sinai, are administering the drug as part of ongoing research on ketamine and depression.
"The rapid antidepressant effects of ketamine in patients with severe, chronic, and treatment-resistant forms of this disease can be a real medical breakthrough," said James Murrough, head of the Program for the Treatment of Mood Disorders and Anxiety Disorders and Professor of Psychiatry and Neuroscience The Icahn School of Medicine, wrote in an October story for Scientific American.
Columbia University's program is one of the first that patients were not forced to show a history of a number of failed treatments for depression in the past. (For Kaiser, patients need to prove that they have tried at least three different antidepressants and have not responded to them.)
However, Lieberman told Business Insider that experts carefully weigh the benefits and risks before recommending treatment to patients, and they always advise people to try traditional medicines first.
"We have to take a very careful history and if [someone has] there is a mood disorder, how were they treated, is the person really not responding to standard treatments?" Lieberman said.
How Ketamine Works
It is thought that ketamine occupies a different brain system than that targeted by traditional antidepressants. It seems to act on key switches in the brain called NMDA receptors. These affect the mood and help to keep the synapses of our brains – the sensitive branches that serve as an ecosystem for our thoughts – flexible and resilient.
Depression damages these brain switches. And while traditional medications can help rescue them with serotonin over time, ketamine seems to be giving its help straight to the source, clogging NMDA receptors like a cork in a bottle, and quickly sipping depressive symptoms.
A series of new research supports this notion of how ketamine works.
Last December, researchers working with depressive and suicidal patients concluded that ketamine cushioned suicidal thoughts better than a commonly used tranquilizer. Most participants in the study, published in the American Journal of Psychiatry, stated that their moods improved within 24 hours of receiving the drug. In some people, this effect lasted more than a month.
Similarly, the authors of a 2012 review of four preliminary studies on ketamine in patients with major depression expressed a surprise at how quickly the drug appeared to produce positive and accurate results.
Read More: Pharmaceutical giants are looking for clues to the next blockbuster depressive drug for ketamine – and science says they have something great
But ketamine, in addition to its steep impact, also has some drawbacks price tag.
Ketamine induces what many people call high. This includes the feeling of being separated from the body and floating, as well as seeing bright colors and shapes. Some experts have suggested that this could lead to addiction problems.
Side effects of ketamine may include blurred vision, headache, and increased heart rate. And doctors still do not know how long the ketamine's antidepressant effects will last. While some patients seem to experience complete relief of their symptoms after several weeks of treatment, other patients either do not respond or only for a few days or weeks. Nonetheless, several clinics outside established medical centers offer treatments, and while some are legitimate, there are others that call Lieberman "frightening" and "aggressive" in their marketing tactics.
"It's not that ketamine should be unavailable – it should be – it just needs to be available in a legitimate, medically controlled and rigorous environment," said Lieberman.
Ketamine inspires several attempts to develop the next blockbuster depression drug.
Ketamine is also researching other new depression medications that affect the brain in a similar fashion. The approach in this channel seems to offer a relief that is better, arrives faster and affects more people than existing medicines.
Allergan, the multinational pharmaceutical company known for Botox and birth control, has recently begun research into an injectable medication for depression called rapastinel, which works on the same brain pathway as ketamine. San Francisco-based drugmaker VistaGen is working on a similar drug called AV-101.
Similarly, in September Johnson & Johnson submitted a nasal spray formulation of ketamine called esketamine to the FDA for review. New York-based biotech company Seelos Therapeutics also has a nasal form of ketamine in its pipeline called SLS-002.
But research is still early, experts say.
"We are currently scratching the surface of the mechanism of action with ketamine," said Cusin this spring.