A drug approved earlier this year by the FDA could help individuals who’ve had limited success with antidepressants.
Ketamine was approved in March in the form of a nasal spray, called Spravato. Previously, ketamine had been primarily given as an anesthetic, and it’s also known for its use in the club scene, called “Special K.”
Now, providers in Asheville are expanding their practices to provide this new and expensive treatment, both in the form of the spray and as an intravenous infusion.
When Jennifer Budai went in for her most recent ketamine infusion, she started feeling uncomfortable. It had been a while since her latest “booster,” as they’re called. She says she fidgeted in her chair and struggled to select a song to listen to while the medication dripped into her veins.
Budai eventually settled into her recliner and relaxed. In the days following her treatment, she says, colors seemed brighter. Sounds outside were less irritating. And her depressive symptoms felt lifted. For instance, she's felt a renewed interest in hobbies, like gardening.
“I find myself thinking about them, and daydreaming about them, and taking pleasure in the thought of doing them,” Budai said.
That’s important, she says, because it helps her be a better mom to her daughter.
Sometimes when you’re in a depressed state you just can’t find pleasure anywhere. Even when I’m interacting with my child, who I love more than anything else in the world, I’m thinking ‘I know I should be taking joy in this but I’m not.’ That for me is key, and that’s why I keep coming back to the ketamine therapy.”
Budai has struggled with anxiety and depression for as long as she can remember. She says she’s tried what she calls a “merry go round” of at least 10 different medications, with minimal success. She started the IV form of ketamine about a year ago and is now on a low dose of an SSRI. She says this is the best she’s ever felt.
Her experience is similarly reflected in studies of patients with treatment-resistant depression. In one study, 70 percent of patients given the ketamine improved, compared to just over half who were given the placebo.
The findings compelled the FDA to expedite the approval process to make it more quickly available. The drug marketed as Sprovato was approved in March. It’s a nasal spray that has to be administered by a physician. And it’s not cheap. A single dose can cost upwards of $600. Several boutique-like clinics have begun to offer Ketamine as an additional service, as the spray and as an IV infusion, which has yet to be approved.
Dr. Linda Dula shows me a small room in the back of Hydrate Asheville. The walls are painted a soft powder blue. It has its own leather lounge chair. There’s a painting of a beach scene on the wall.
“You’re being monitored constantly, medically, but we want it to be relaxing. We don’t want it to feel like a doctor’s office,” Dula said.
The IV drips aren’t covered by insurance, costing around $400 for a single treatment. Dr. Dula says she’s hopeful that will change, given the new nasal spray as well as the interest she’s hearing from fellow physicians.
It marks a shift in behavioral health that’s paying more attention to the possible therapeutic benefits of psychedelic drugs, long cast off to the realm of raves and jam band concerts. In Asheville, there’s a handful of behavioral therapists who offer guidance following a psychedelic trip. Verena Wieloch is a licensed professional counselor and a clinical addiction specialist in North Asheville. To be clear, she says, she does not provide psychedelic drugs to her clients.
“Yeah, no I’m not offering it right now. I’ve been trained. It is not legal right now. It is legal for the trials. I think all of us are looking forward to the day it does become legalized,” Wieloch said.
She’s certified by the Multidisciplinary Association for Psychedelic Studies, or MAPS. The educational organization is currently applying for expanded access clinics with the FDA. If approved, that would allow patients to receive treatment with psychedelics, like psilocybin and MDMA, outside of a clinical trial.
“I find a lot of people who get curious about this don’t want to be on medications forever. They don’t want to be leashed to that. They want to feel a little more free,” Wieloch said. “The wonderful thing about a lot of psychedelic research is one experience can really change things for people.”
Wieloch cautious, however, that like any medication -- there is no “miracle solution” and the effects won’t be the same for everyone. She says more research and understanding of the drugs and their effects still has to be done.