With the legalization of marijuana, Americans’ attitudes towards these substances are loosening—along with research showing the potential for healing with many of these drugs: particularly psilocybin (mushrooms), MDMA (ecstasy), and ketamine (Special K). Additionally, as rates of depression rise—by more than 25% during the pandemic alone—and more and more Americans are taking antidepressants, less than 50% of people find an antidepressant that works sufficiently for them on the first try.
What the Research Says
Research for other psychedelics shows promise, including long-term symptom relief with psilocybin, but currently, ketamine is the only hallucinogenic legal in the United States, as it is also used as an anesthetic for surgery. Pharmacologically, ketamine is considered a dissociative anesthetic, although it can have some hallucinogenic effects. Ketamine for depression has been studied in earnest since the late 1990s, with a study from the year 2000 touting its antidepressant properties. Its biggest strength is how quickly it works. One study reported a significant reduction in suicidal ideation in people given a ketamine infusion in the emergency room in 90 minutes, compared to the weeks an antidepressant medication might take. Ketamine has been used off-label since the early 2000s for depression, but in 2019, the nasal ketamine preparation Spravato was fast-tracked for FDA approval because of its promise. Typically ketamine is administered in a clinic, either via an intravenous infusion or through the Spravato nose spray—both of which require patients to be observed during the experience and after to monitor for side effects like nausea, elevated blood pressure, confusion, etc. Sometimes, a ketamine clinic will also have a therapist on staff for an “integration” session afterward to process what might have come up during the “trip” and discuss how to integrate insights into the person’s life post-experience.
The Rise in Psychedelic Teletherapy
The coronavirus pandemic created a perfect storm for ketamine teletherapy to be born: a dramatically increased need and awareness for mental health care services, a meteoric rise in telehealth services, and a loosening of restrictions to allow for the expansion of telehealth services. These changing restrictions allowed doctors to prescribe controlled substances like ketamine via telehealth, whereas previous regulations prohibited ketamine teletherapy unless the patient had previously been seen in person. Many are lobbying for these permissions to be extended indefinitely. If not, these startups could be in jeopardy.
Psychedelic Teletherapy Companies, Costs, Complications
While there are also individuals who are offering ketamine teletherapy, most of the work in this space is done by a handful of startups that are venture-backed or publicly traded.
Field TripKetamine OneNuminusMy Ketamine HomeMindbloomBetter UNue Life Tripsitter.clinic
Many of these companies feature slick pitch decks for investors touting the market potential—that is, the potential for more people struggling with mental illness to make money off. Providing ketamine via teletherapy is even explicitly highlighted as a cost-cutting measure so that more patients can be seen. One month of treatment at Field Trip Health is $1250, which includes six doses of ketamine, four group integration sessions, and one health coaching session. Mindbloom runs roughly the same, with six doses, two psychiatric clinician consultations, three guide sessions (prep/integration), unlimited group integration sessions, and unlimited messaging for $1068 a month. Venture-capital-backed companies typically measure success in dollars, not patient outcomes, which may lead to cutting corners. However, if these companies can safely scale, they may bring access to those who might not otherwise have access to this type of care.
How Psychedelic Teletherapy Works
We spoke with Dr. Michael Verbora, Medical Director at Field Trip Health, about their at-home ketamine process. Field Trip has partnered with Nue Life, another ketamine company that specializes in at-home ketamine, to manage the process. First, he says, patients inquire about the process and they undergo a consultation with Nue Life’s team. If they’re approved, they’re sent a single dose of ketamine. From there, he says “they would log on, do a bunch of check-ins and monitoring and compliance with the ketamine. They would do their therapy and then report any side effects or benefits and then meet with a coach in the coming days.” He explains that there are two main ways to do ketamine-assisted psychotherapy: “what we call the psychoanalytic way—where you take a really small dose and you feel kind of normal but a little more lubricated to speak openly about your pain and suffering. There’s also the high dose, where we encourage people to go inward and be on their own.” Field Trip requires each patient to have a “sitter” to be present, monitoring the patient, in case of side effects or if a patient needs anything. The sitters are trained in advance and must show their faces on Zoom prior to the start of the session.
What Conditions Does Ketamine Help With?
Ketamine may help with a number of different conditions, but it is most frequently used with treatment-resistant depression (depression that has not significantly been helped by several medications). Some other conditions it may help with are:
Post-traumatic stress disorder (PTSD) Chronic pain Anxiety disorders Bipolar disorder Obsessive-compulsive disorder Suicidal ideation
Although ketamine is often used for suicidality, Verbora says, “if we think someone is high risk for suicide, we’re going to recommend a higher level of care or not doing ketamine at this time,” and won’t recommend at-home ketamine for those people. Ketamine or other psychedelic treatment may also increase symptoms and distress in certain people with trauma or PTSD. Verbora won’t recommend those patients for at-home ketamine either.
The Future of Psychedelic Teletherapy
Field Trip Health is developing its own psychedelic, called FT-104, and has filed a patent for it. The psychedelic would work somewhat similarly to psilocybin, but with a two-to-three-hour experience, rather than the three to six psilocybin might usually take. Verbora says that Field Trip is planning on moving to other psychedelics as they are approved in the United States but that he might not immediately offer them via telehealth as those experiences are generally longer than an hour-long ketamine experience. However, the data is exciting. One study showed a significant antidepressant response in patients who did just two sessions of psilocybin—and sustained the results at a six-month follow-up. Many companies are currently working on developing psychedelic medications, and psilocybin and MDMA are currently in advanced-state clinical trials for the treatment of treatment-resistant depression and post-traumatic stress disorder.
Is At-Home Ketamine Safe?
Ketamine was initially developed and used (and is still used) as an anesthetic, so it is not without side effects, including the possibility of blood pressure elevating by up to 50%. In 2017, the American Psychiatric Association released a consensus statement on the use of ketamine in the treatment of mood disorders, advising clinicians on how to work with ketamine. The guidelines call out blood pressure elevation and psychomimetic symptoms (those that mimic psychosis). The guidelines also recommend being able to stabilize a patient in case of an emergency by delivering oxygen or providing cardiac life support until the patient can get to the hospital. Rachel Gersten, a licensed mental health counselor, is skeptical. “It needs to be monitored by a qualified professional, preferably one that develops a close, ongoing working relationship with the patient to understand them holistically rather than dropping some medication on them and leaving,” continues Gersten. However, some research shows that although sub-lingual ketamine (the form that is often used in these home treatments) may have much lower bioavailability than intravenous ketamine—it does also come with fewer side effects. Bioavailability refers to how much of the medicine gets into your system.
A Word From Verywell
While ketamine treatment for depression has been around for some time now, it is still growing as an industry, and a 2018 investigation found wild inconsistencies among brick-and-mortar clinics in terms of following the recommendations of the American Psychiatric Association—including not thoroughly screening patients or having adequate medical and mental health staffing, as well as over-hyping the potential benefits of the treatment. As psychedelic teletherapy is brand new, it’s crucial to do your research and ask plenty of questions before considering this is a treatment option.
