Our Guide to Ketamine Telemedicine: Cutting Edge Mental Healthcare Here Now

We are in the midst of a mental health crisis with rates of depression and anxiety only worsening over the past two years as we have faced a raging pandemic, lockdowns, and economic anxiety. Even before the pandemic, in 2019, nearly 20 million Americans were estimated to have had at least one major depressive episode, with treatment-resistant depression (TRD) occurring in approximately 30% of cases. TRD typically refers to at least "two prior treatment failures." It's clear we need an all hands on deck approach as well as out of the box thinking to address this epidemic. Telemedicine has already proved an incredibly valuable asset in bridging the access gap in mental healthcare and now, for the hardest to treat cases of depression, it's offering a new option: ketamine. 

Everyone from comedian Whitney Cummings, “Sopranos” creator David Chase, and NBA Champion Lamar Odom have tried ketamine as a treatment for depression. It’s been just over two decades since the anasthetic was first reported as effective for treatment-resistant depression but its just recently gained wider acceptance and broken through its past stigma as a club drug. Early studies and treatment have focused on IV administration but telemedicine has opened the door to treatment at home.

Ketamine History

Perhaps best known to the public as the club drug "Special K," ketamine was first synthesized in 1962 as an anasthetic alternative to PCP. Ketamine's antidepressant qualities first became apparent in the '90s and the first human trial demonstrating ketamine's effectiveness treating depression was published in a 2000 study involving intravenous treatment. In recent years, IV clinics have provided ketamine infusions in the range of approximately $700 per session. 

In March 2019, the FDA approved a nasal spray form of ketamine (S-ketamine) from Janssen Pharmaceuticals for TRD. The spray has largely the same effects as other forms of ketamine but must be taken in-person under clinical supervision. It can cost several thousand dollars a month depending on the treatment regimen but, unlike IV or oral administrations, it may be covered by insurance as an FDA approved treatment.

Ketamine Benefits

Ketamine offers two major benefits compared to traditional antidepressants: 

1. It's fast-acting. Unlike traditional antidepressants which typically take weeks or even months to take effect, patients who take ketamine often report feeling better within hours.

2. It can be effective with treatment-resistant depression (TRD). For up to a third of patients, standard treatments such as psychotherapy, antideppressants, and even electroconvulsive therapy fail to provide relief. For these patients, ketamine may be the key to managing their symptoms.

Ketamine Effectiveness

Since the first study published in 2000, ketamine has been shown in multiple publications to provide a rapid antidepressant effect. Ketamine has been studied alone vs. placebos and active placebos with generally favorable results in many studies. Furthermore, multiple randomized controlled trials (RCTs) have demonstrated the effectiveness of oral ketamine in treating depression. While the anti-depressant effects of ketamine are felt rapidly (compared to several weeks for conventional SSRIs), they are transitory, generally peaking within a day and lasting no more than a couple of weeks. This is why ketamine telemedicine providers stress the importance of integration, or taking the lessons learned during a ketamine session and integrating them into a patient's daily life for sustained benefit from treatment.

Ketamine Safety

No matter what form it's taken in, like any treatment, ketamine is not without its potential side effects including dissociation, dizziness, nausea, and sedation. Additionally, ketamine does carry the potential for abuse and addiction and there are questions about its use as a long-term treatment, which has been shown in chronic users to actually lead to depression. It's important to note this finding was among recreational users who took unregulated doses outside the care of a medical provider.

Overall, a 2019 review found that 

"{...} safety and tolerability profiles are generally good at low doses and with short-term treatment in depressed patients. The adverse events associated with ketamine usually occur with very high doses that are administered for prolonged periods of time and can be relieved by cessation {...}."

While oral ketamine is generally very safe for most patients, it is important to note that this is still an off-label treatment for depression, and the research available is less than that for IV and intra-nasal routes. As with any treatment, patients need to speak to their doctors about potential risks and benefits.

Ketamine Telemedicine Companies

Telemedicine startups such as Mindbloom, Reconscious Medical, KetaMD (who has partnered with Lamar Odom), and My Ketamine Home are offering patients the ability to receive ketamine treatment at home. These services all offer patients treatment in the form of sublingual tablets, or troches, which dissolve under the tongue and are administered over six initial sessions. Sublingual tablets are not only more convenient than the alternatives but also far more affordable, although they are generally not covered by insurance as an off-label treatment. 

Ketamine Telemedicine Affordability

One of the biggest benefits of administering ketamine via telemedicine is affordability. Intravenous clinics and nasal sprays can cost in the thousands of dollars per month, while telemedicine services such as Mindbloom charge less than $400 per month. Although still a significant amount, especially since insurance does not typically cover treatment, virtual ketamine providers have certainly increased access for patients whose previous options had been out of reach. 

The Future of Ketamine Telemedicine

Next year will mark sixty years since ketamine was first synthesized and new frontiers for its use continue to be explored. Studies using ketamine to treat post-traumatic stress disorder, substance use disorder, and obsessive-compulsive disorder have shown promising results. Additional studies are needed to establish ketamine's efficacy as a first-line treatment for depression.

Wider acceptance of ketamine also helps open the door to the wider field of psychedelic medicine including LSD and psilocybin, the latter of which recently showed high efficacy in its largest RCT to date. 

If you're a patient with TRD, it's important to know that treatment options are available and are easier than ever to access as telemedicine becomes more widespread. If you're a medical provider looking to join this next frontier of psychiatric telemedicine, we've got you covered with the latest 100% remote opportunities, updated daily.  

Disclaimer: WhiteCoatRemote.com does not provide medical advice, diagnosis or treatment. The contents of WhiteCoatRemote.com are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately.