Be Aware of These Nine Questionable Clinics

John Watson

Disclosures

August 20, 2018

In This Article

Ketamine Clinics Rise on Strong Data in Depression

In 2000, many may have doubted the results of a small study that reported that seven patients with major depression significantly improved after intravenous treatment with ketamine,[15] which at that point was more famous for its role as an illicit club drug. This doubt remained for many when ketamine's positive effects were replicated in a randomized, placebo-controlled trials 6 years later.[16]

Such was the case for David Feifel, MD, PhD, director of the Center for Advanced Treatment of Mood and Anxiety Disorders at the University of California, San Diego.

"I hoped my skepticism was wrong, but at the time if I had to place a bet, it would have been that this really is not going to pan out as promising as it seems," said Feifel.

Shortly thereafter, Feifel began administering ketamine to his own patients with severe, treatment-refractory depression, with similarly substantial results. He has observed similar results in other psychiatric conditions, such as posttraumatic stress disorder and anxiety as well.

In the interim, ketamine's role in treating these conditions has been substantiated by a number of peer-reviewed publications.[17,18,19,20,21]

In his personal practice, Feifel said that the acceptance of ketamine is evident in the fact that approximately half of his referrals to his ketamine program come from psychiatrists, which was not the case in earlier years.

How Is Ketamine Best Delivered?

Instead, the more pressing issue regarding ketamine has become how this treatment is best administered. There has been increasing criticism of ketamine clinics, specifically surrounding the sometimes high payments they solicit from desperate patients and the fact that they are often operated by anesthesiologists and emergency department doctors with little to no experience in dealing with major psychiatric disorders.[22]

"I have learned that the best outcomes from ketamine come from providers who have the skill and experience to use ketamine as part of a suite of options and in conjunction with other traditional and more advanced approved treatments," Feifel said. "For example, in my practice, it is not uncommon that I will recommend a regimen for a treatment-resistant patient that includes transcranial magnetic stimulation and ketamine. Along the way, I may also suggest adjustments in the patient's psychotropic medication regimen based on my observations of their response to the treatment regimen or if I detect a previously unrecognized condition—for example, attention-deficit/hyperactivity disorder. These sophisticated approaches are things that patients typically don't receive from the growing number of 'one-trick pony' clinics."

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