WEST ORANGE, N.J., March 4, 2019 /PRNewswire/ -- FDA's approval of ketamine to address depression classified as 'treatment resistant' is a double-edged sword. "Ketamine is currently used as an anesthetic, but it is also an abusable, addictive street drug," commented Indra Cidambi, M.D., Addiction Expert and Medical Director at Center for Network Therapy (CNT). The approved medication is low dose and has to be administered at a facility, limiting abuse potential. "It is welcome news for millions of patients suffering from untreated depression who could now find relief," said Dr. Cidambi. However, she cautioned, "If the cost to the patient is high and access to ketamine treatment difficult, it could divert demand to inexpensive street ketamine for immediate symptom relief and cause an explosion in addiction to ketamine."
FDA-approved ketamine, or esketamine, is low-dose (28mg nasal spray) and well below the threshold for delivering a high. The FDA recommends that patients try 2 traditional antidepressants before their depression can be classified as 'treatment resistant.' A patient may require 10-12 ketamine treatments a year. In addition, this medication has to be administered at the physician's office, not given out as a prescription. Consequently, the risk of the FDA-approved ketamine being abused or diverted is low.
"More than one of three of 16 million individuals with depression in America do not receive any treatment and 3 of 10 individuals prescribed antidepressants do not derive any benefit from it, suggesting millions of patients with depression could now find relief with ketamine," said Dr. Cidambi. Besides, ketamine provides immediate relief from depression symptoms while traditional antidepressants take weeks to kick in.
However, FDA approval of ketamine could cause collateral damage. "It is important to remember that 1 in 5 individuals addicted to drugs are using street drugs to self-medicate their unmet mental health care needs," noted Dr. Cidambi. Ketamine is a dissociative anesthetic used in humans and animals, but it is mostly used by veterinarians. Individuals who abuse Ketamine (injected, snorted or smoked) need large doses (over 100mg, about $10) and it causes a dream-like state, detachment from reality, altered perceptions and hallucinations.
"FDA's stamp of approval for ketamine to treat depression could encourage patients who have no access to treatment or those who find it difficult to access ketamine treatment to seek ketamine on the street to self-medicate symptoms of depression," cautioned Dr. Cidambi. Ketamine is an inexpensive street drug (likely much cheaper than when obtained through legal channels) and it provides immediate relief from symptoms, incentivizing patients with depression symptoms to gravitate to this alternative. "This could cause an explosion in addiction to ketamine, which currently is not very common," added Dr. Cidambi.
"Recall that when states belatedly started to implement restrictions on opiate pain pill prescriptions, many patients who were already on opiate prescriptions turned to street heroin for relief from pain or withdrawal symptoms," cautioned Dr. Cidambi.
About Dr. Cidambi Indra Cidambi, M.D., Medical Director, Center for Network Therapy, is a pioneer in Addiction Treatment. She introduced Ambulatory Detoxification for treating withdrawal from Alcohol, Benzodiazepines, and Opiates. She has a fellowship in addiction from NYU/Bellevue and is board certified in Addiction Medicine and Psychiatry.
About Center for Network Therapy (CNT) CNT is New Jersey's first facility to be licensed to provide Ambulatory (Outpatient) Detoxification and Withdrawal Management for alcohol, anesthetics, benzodiazepines, and opiates. Led by Board Certified Addiction Psychiatrist, Indra Cidambi, M.D., experienced physicians and nurses provide high-quality treatment. Dr. Cidambi and team have successfully detoxed over 1500 patients in 5+ years.