Drug cousins ketamine and esketamine are being used more frequently as anti-depressants. But that doesn’t mean they can be found anywhere and be used by anyone. Here are some things to know about ketamine and esketamine therapy, and what to do if you want to try it for yourself.
Ketamine and esketamine therapy are all the rage, but they’re still not as easily accessible as cannabis. Fortunately, there has been more focus on these compounds in recent years and the market is poised to explode in the very near future. Remember to subscribe to The Psychedelics Weekly Newsletter for more articles like this one. And save big on Delta 8, Delta 9 THC, Delta-10, THCO, THCV, THCP & HHC products by checking out our “Best-of” lists!
What are ketamine and esketamine?
Esketamine is a close relative of the drug ketamine, which has been used as a club drug since the 80’s. Ketamine was discovered in 1962 at Parke-Davis, a pharmaceutical company, in an attempt to find a strong anesthetic. When it was discovered, it was described to be a compound with “cataleptic, analgesic and anesthetic action but without hypnotic properties.”
The term ‘dissociative anesthetic’ has since been used to describe it, as it has a tendency to disconnect the different parts of the brain. Ketamine’s chemical formula is C13H16ClNO, and it’s only cleared for use as an anesthetic for humans and animals, though it has been found useful for depression and pain issues as well, and is used off-label for these purposes.
Esketamine is much newer than ketamine, which shares its chemical formula. It first came out in 1997 in Germany as an anesthetic. While being used in this way, it was discovered that it can very quickly produce anti-depressant effects, and study into its use for this purpose began. The compound finished trials for treatment-resistant depression in 2017 in the US, and the first company to file its application for a new medication with the FDA, was Johnson & Johnson, which subsequently put the drug out as Spravato upon approval on March 5th, 2019.
The current approval stands as a compound to be used in conjunction with other standard monoamine antidepressants. The approval was updated in 2020 to include use for suicidal thoughts. This is a testament to how quickly and effectively it works, that it would be approved for something which requires the fastest of onsets. Ketamine and esketamine are provided through clinics, and administered either as a nasal spray, or IV.
How legal is this?
I want to take a second to clear something up. When talking about ‘esketamine therapy’, it refers to the only FDA-approved medication put out by Johnson & Johnson called Spravato, which is a nasal inhaler. When talking about the term ‘ketamine therapy’, it generally refers to ketamine IV treatments used for the management of pain and psychological issues like depression, and is administered as an off-label use.
While this doesn’t have to matter, it creates confusion when talking about what the drug can be used for, and how its prescribed. Ketamine is currently a Schedule III drug approved for anesthesia (its placement making it safer, according to the DEA, than cannabis). Ketamine will only be officially prescribed for anesthesia purposes for now, because that’s all its approved for. It has no official approval for psychological issues or pain. This, however, doesn’t mean that ketamine won’t be given for these things.
Off label use refers to “the use of pharmaceutical drugs for an unapproved indication or in an unapproved age group, dosage, or route of administration. Both prescription drugs and over-the-counter drugs (OTCs) can be used in off-label ways, although most studies of off-label use focus on prescription drugs.”
If you’re wondering if this is legal, it actually is. According to the FDA, “once the FDA approves a drug, healthcare providers generally may prescribe the drug for an unapproved use when they judge that it is medically appropriate for their patient.” In this way, though ketamine has not been approved for use with depression, it can still be administered for it, making ketamine infusion clinics legal, even if being used for something not authorized for the drug.
Since ketamine is still a controlled substance, its use – whether off-label or not, must follow federal and state laws for Schedule III drugs. However, the FDA has no regulation set up for ketamine infusion clinics, and neither do any of the US states. This means that options for treatment really can pop up anywhere, but it should be remembered when considering clinics, that there is no regulation for patient safety protocols.
How to get a prescription for ketamine or esketamine therapy
The first thing is to get your prescription. When it comes to esketamine, you’ll either go to your primary care physician who will give you a referral for a psychiatrist, or you’ll work with your already existing psychiatrist. From going through different sites, it becomes clear that like with any other psychological issue, the prescription of esketamine is very much done based on subjective opinions, meaning if your therapist doesn’t like the idea of it, or doesn’t believe in it, you might need to find a more accepting doctor.
Things to be assessed include current and past medications and how effective they were, family history, substance abuse issues, and a general look at overall medical history, including past experiences with anesthesia, likely as a way to assess how well a patient will respond to esketamine.
Funny enough, though psychedelics have repeatedly shown strength in dealing with psychiatric disorders, doctors are less likely to prescribe it if a patient has a disorder like schizophrenia. Other issues that will stand in the way include: pregnancy, seizure disorders, the use of aminophylline for COPD or asthma, and those with high blood pressure, cardiac disease, and pulmonary issues.
When it comes to ketamine, since its not approved for uses outside of anesthesia, its given as an off-label medication for depression and pain. Many patients go directly to a ketamine clinic, where they are evaluated by the therapists employed. Conversely, some family doctors will refer patients directly to these clinics for treatment. Though unregulated for this purpose, ketamine is still only administered medically, and interested patients will have to receive doctor approval before using ketamine or esketamine for treatment.
How to find a clinic for ketamine or esketamine therapy
This is where it gets a bit dice, since you can’t just walk into a pharmacy to pick up a prescription. Each patient has to find a clinic close to them for their therapy, and this can be difficult depending on location. Interested patients can use the following sites to find a relevant clinic.
Johnson & Jonhnson’s Spravato is the most used version of esketamine, and clinics that administer it can be found here. Users can input their locations to find clinics in their area that administer the treatment. Depending on where a person is, there can be various options, or essentially none at all, meaning if you live in a place where there isn’t a provider nearby, you might be out of luck.
If looking for a ketamine infusion, the Ketamine Clinics Directory has listed locations across the US for treatments. This directory shows updated clinic locations in the US, and makes clear that many areas of the country are very much underserved at the moment, leaving people in those locations at a loss for using this treatment. In this way, ketamine and esketamine aren’t the most easily available options.
The cost of ketamine therapy
Apart from simply finding a location to get it, ketamine and esketamine therapy come with another big issue, the cost. Whereas every standard antidepressant is covered by insurance, this is not always the case for esketamine. Some insurance companies will cover all or part of the cost, depending on the exact type of therapy. For example, those using FDA approved Spravato nasal spray, have a better chance of being covered.
If there is no coverage – which will always be the case with ketamine, the unfortunate reality is that most people really won’t have access. According to TMS & Brain Health, standard pricing for treatment runs about $400-800 per session, making it an expensive treatment. The same site claimed most clinics will create their own treatment schedule per individual, with standard schedules offering the treatment twice a week for a month, and then once a week for following months, for however long its designated necessary. This schedule is almost always followed when dealing with Spravato nasal inhalers.
Another clinic called Revitilist Clinic which works with both ketamine and esketamine, put the cost at $474 for each Mood Protocol Infusion (for depression, suicidal ideations, anxiety, OCD, and PTSD), $600 per each two-hour Pain Protocol infusion, and $800 per four-hour esketamine infusion. Once again, these are not low prices, and this will make getting such treatments very difficult for those who cannot pay these sums out of pocket. For this reason, while I almost never promote a large pharma brand, it might be beneficial for interested users to seek out a Spravato prescription, in order to get at least some costs covered.
When it comes to medications, accessibility is extremely important. As of right now, ketamine and esketamine therapy aren’t exactly widely accessible, leaving many people, in many locations, without any access. Hopefully in the future this will change, especially with impending legalizations for fellow psychedelics MDMA and psilocybin.
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Disclaimer: Hi, I’m a researcher and writer. I’m not a doctor, lawyer, or businessperson. All information in my articles is sourced and referenced, and all opinions stated are mine. I am not giving anyone advise, and though I am more than happy to discuss topics, should someone have a further question or concern, they should seek guidance from a relevant professional.