A Tale of Two Ketamines: Addressing the Headlines around Elon Musk

It’s not every day that the President of the United States tweets about your medical specialty. But the recent public feud between Donald Trump and Elon Musk has catapulted ketamine, a common medication used for anesthesia and depression, into the national spotlight. While the headlines are filled with political drama, media outlets from The Nation and The Atlantic to Vox and The New York Times are exploring ketamine’s complex and contradictory role in modern life.

On one hand, ketamine has emerged as one of the most promising and rigorously studied treatments for depression in decades. On the other, it has been well-documented as a drug of misuse when used recreationally, often in extremely high doses, sometimes daily, and in unsafe environments. While both narratives are true, public discourse often fails to distinguish between them, sacrificing nuance for spectacle.

As we have shared with our community time and again at Ember, the details surrounding ketamine matter, and we feel passionately that the abuse of ketamine should not be conflated with the safe and effective medical treatment of depression.

Ketamine is the most extensively studied drug for depression over the past 30 years (source). When administered intravenously (IV) within a specific dosage window, it alleviates depressive symptoms in 3 out of 4 patients (source). Clinical consensus statements, including those from the VA, have called IV ketamine a gold standard for people suffering from treatment-resistant depression (source, source). Insurance companies are increasingly recognizing its value and are beginning to reimburse for care (source). When used responsibly in medically supervised settings, IV ketamine offers profound relief for millions, and has the potential to save billions in downstream healthcare costs (source).

But ketamine misuse is also real, and growing (source). Recreational use of ketamine, especially at high doses and over long periods, has serious risks. It can cause bladder and liver damage, cognitive impairment, and in rare but tragic cases, death when combined with other substances or taken in unsafe settings (source, source). The FDA has issued warnings against unsupervised at-home use for precisely these reasons (source).

Many media narratives blur these distinctions. A recent Slate podcast What Next: TBD, speculates about Elon Musk’s alleged ketamine use, and issues vague warnings about bladder damage. The concern is legitimate, but it lacks context. Typical IV ketamine treatments for depression infuse 50 milligrams of the medication, once every few weeks (source). By comparison, ketamine-related bladder issues occur primarily in individuals taking multiple gram-level doses daily (source). To put that into perspective: the difference is akin to drinking 1 cup of coffee every few weeks versus drinking 100–250 cups of coffee every day.

Moreover, recreational ketamine can be adulterated, sometimes with lethal additives like fentanyl. Medically produced ketamine, administered by trained clinicians in controlled environments, is FDA quality-controlled, carefully dosed, and evidence-based. The molecule may be the same, but the circumstances, purpose, and outcomes could not be more different.

While media coverage often lacks the nuance this space requires, it offers an opportunity. Greater public awareness about ketamine opens the door to education about a life-saving treatment for one of the most devastating public health crises of our time. Depression affects over 30 million Americans, many of whom do not respond to traditional treatments (source). For them, ketamine can be a lifeline.

Ultimately, we don’t know how or why Elon Musk may be using ketamine. But we do know this: IV ketamine, when used properly, under clinical supervision, and for the right medical indications, helps individuals reclaim their lives. The national conversation needs to catch up with the science, and with the realities of the people we treat every day. Americans deserve to understand the difference between misuse and medicine.