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Ketamine can also exacerbate underlying heart and blood pressure conditions, Grunebaum says, “and so there needs to be adequate medical monitoring and supervision available for safety.” Even
the FDA-approved esketamine nasal spray requires patients to use the medicine in a doctor’s office or clinic, under the supervision of a health care provider. What’s more, with ketamine, a
controlled substance, there’s potential for addiction, Tankha says, “and so close monitoring must be done.” In October, the FDA issued a warning about using ketamine products at home and
without medical supervision. The agency said it “understands that the ability to obtain such products through telemedicine platforms and compounders for at-home use may be attractive to some
patients. However, the lack of monitoring for adverse events, such as sedation and dissociation, by an onsite health care provider may put patients at risk.” The FDA said it received an
adverse event report for a person who experienced respiratory depression — breathing too slowly or shallowly — after taking an oral form of ketamine outside of a health care setting for the
treatment of PTSD. “The patient’s ketamine blood level appeared to be twice the blood level typically obtained for anesthesia,” the agency said. According to the U.S. Drug Enforcement
Agency, an overdose of ketamine can cause unconsciousness and dangerously slowed breathing, which can lead to respiratory failure or heart attack. 3. IT’S NOT A FIRST-OPTION TREATMENT If
you’re interested in learning more about ketamine therapy, skip the mail-order marketers and start by talking to your primary care physician, Tankha says. If they’re not familiar with
ketamine, ask to be referred to a provider who is — and then, consider getting a second opinion. “When we’re talking about off-label uses, you want to be an informed consumer and get as much
information as possible,” he says. Grunebaum predicts ketamine therapy, which for some can be lifesaving, will stick around, especially for people with treatment-resistant depression.
Research suggests that around 30 percent of people with depression don’t respond to traditional treatments. “But I wouldn’t expect to see it become a widespread, first-line treatment for
someone early in their natural history of their illness,” he says. “We have strong evidence-based ways of treating depression and anxiety that should be considered before ketamine,” Das
says. “And unfortunately, those options are underutilized, or they’re not fully utilized.” Studies show about half of people with a mental illness don’t receive treatment for it. Ketamine,
Grunebaum says, is a last resort, “when many other things haven’t worked.” 4. IT’S SIMILAR TO PCP Ketamine is closely related to phencyclidine (PCP), a powerful dissociative anesthetic
that was similarly abused in the late 1970s. Los Angeles County alone recorded 192 PCP-related overdoses between 1976 and 1978, a period of time when PCP abuse peaked. Popularly known then
as “angel dust,” it was either snorted in powder form or, as a liquid, soaked in cigarettes or marijuana and then smoked. PCP is no longer used medically as an anesthetic due to serious
adverse effects. Ketamine has one-tenth the potency of PCP but both drugs distort perception of sight and sound and produce feelings of detachment (or dissociation) from the environment and
self. _Editor’s note: This story, originally published Dec. 19, 2023, has been updated to include new information._