Response to NYTimes “Can We Stop Suicides?”

Our long-form Response to the NYTimes article: Can We Stop Suicides?

Thank you, Moises, for drawing attention to this important issue. I’m an ER doctor by training running a ketamine clinic for depression and feel compelled to share a bit about the experience of my patients as they relate to your article.

The patient experience – safety, well-being, and comfort – is our primary focus and concern at Ember Health, a topic considered in this article. “Dissociation” is introduced, a term that merits some context. Studies have shown that the most common dissociative effect of ketamine is the loss of sense of time. My patients, for example, often tell me that the infusions feel like they last significantly longer than 40 minutes. More visual or psychedelic dissociative feelings are entirely dose dependent, and start to occur with doses that are double what we typically administer.

Most of my patients describe the experience of the infusions we provide as calming and meditative. While negative thoughts have often predominated for days and sometimes weeks, the infusions offer relief from downward spiral thinking, and allow patients to reflect on what matters in their lives – their family, the love for their children. This degree of perspective-giving has been one of the most gratifying elements for me and my team. I recently had one patient who, after having felt suicidal thoughts, had an infusion and afterwards described how, one by one, he thought of each person in his life for whom he is grateful. The following week, he was able to motivate for activities that had previously felt overwhelming – such as starting the search for a new job.

A few other technicalities worth clarifying in the article:

First, ketamine is well documented to be a non-Addictive medication, the WHO did an investigation into this in 2014. There is no physical dependency established with the use of ketamine, and patients who stop using the drug do not experience symptoms of withdrawal. That said, Ketamine can be abused by people seeking an altered mental state.

Source: World Health Organization

Second, more than half of psychiatric medications are off-label. Anticonvulsants and lithium are both part of standard of care for depression, despite them never having been approved by the FDA for depression in the same way that Ketamine is off label for depression.

Source: PLoS ONE

Third, regarding the clinical evidence for ketamine, please remember that these clinical trials are prohibitively expensive. Ketamine is generic and there is no single company that is willing to invest the millions of dollars required to conduct the definitive trial that you have called for. That said, there have been 9 Randomized, Placebo-Controlled studies showings its significant benefits.

Source: See here list of journals

Fourth, Ketamine is now being offered at major medical institutions. On the West Coast, the University of California in San Diego has been offering the infusions since 2010 and Kaiser Permanente started administering ketamine for depression in 2015. On the East Coast, major medical centers offering ketamine include Columbia University, Emory University, Yale University, and Massachusetts General Hospital. Several other medical centers, including the Cleveland Clinic, NYU, 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.

Thank you again for your excellent reporting. I look forward to continuing these conversations to get the word out and help as many people as we can.