In a world where the struggle against mental health issues rages on, novel treatments have emerged, offering hope and respite to those suffering from depression, suicide, post-traumatic stress disorder, substance abuse, and chronic pain.

A recent article in Daily Maverick titled “South African psychiatrists gear up to treat depression with psychedelics” highlights the exciting developments in the realm of psychedelic therapies for mental health. Among these treatments, ketamine infusions stand out as a very legal, but hidden remedy, with promising results.

Ketamine, long known for its use as an anaesthetic is now emerging as a powerful tool in the fight against mental health disorders. Recent systematic reviews have shed light on its potential value, offering new hope for those who have exhausted conventional treatment options.

Unfortunately, this off-label use of ketamine prevents it being advertised to patients due to South African law and it can only be recommended by psychiatrists and psychologists, who often appear hesitant to do so.

Depression

Depression is a debilitating condition affecting millions worldwide. Traditional treatments often take weeks to show results, and for some, these treatments may be ineffective. Ketamine infusions, however, have shown rapid and remarkable antidepressant effects.

A recent systematic review highlighted the effectiveness of ketamine in rapidly alleviating depressive symptoms, especially in cases of treatment-resistant depression. A single infusion can produce results with 80% of such patients, many lasting from one week to one month. Current global best practice of six infusions over two to three weeks can produce results for much longer.

Suicide prevention

The devastating rise in suicide rates demands innovative interventions. Ketamine infusions have been explored as a means to reduce suicidal ideation. A recent systematic review has indicated that ketamine may offer an effective and fast-acting intervention to prevent suicide in individuals experiencing intense suicidal thoughts. A randomised controlled trial in 2023 showed that ketamine infusions can be as effective as electroconvulsive therapy (ECT) but without the many side effects of ECT: muscle pains and loss of memory.

Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder can haunt individuals long after their traumatic experiences. Conventional therapies, while effective for some, may not work for all. Ketamine infusions, as suggested by systematic reviews, have shown promise in reducing the symptoms of PTSD, offering hope to those living in the shadow of trauma. The duration of remission of symptoms is still not clear with most studies having only short follow-up periods.

Substance abuse

The battle against substance abuse is relentless, with many struggling to break free from the cycle of addiction. Ketamine infusions, as per recent reviews, may aid in reducing cravings and addressing the underlying psychological factors contributing to addiction.

This novel approach could provide a lifeline to those trapped in the throes of substance abuse. A study in Russia in 2007 showed 50% abstinence by heroin-dependent individuals at a one-year follow-up, after three bi-monthly infusions.

A study on ketamine for cocaine-dependent individuals showed that almost 50% of those having a single infusion of ketamine had maintained abstinence by the end of the trial with craving scores at almost 60% less by the end of the trial.

Benefits are being proven in disorders of alcohol, smoking, cannabis, and benzodiazepine use. Work is happening in Soweto on ketamine’s use for nyaope and crystal meth (tik), common drugs of abuse in townships.

Chronic pain

Chronic pain, both physical and psychological, can significantly diminish one’s quality of life. Ketamine infusions, as indicated by systematic reviews, have demonstrated effectiveness in alleviating chronic pain, making it a viable option for those seeking respite from this debilitating condition.

The format of administration is different to mental health conditions above, but ketamine has been found to have significant value in treating fibromyalgia, chronic regional pain syndrome, trigeminal neuralgia, migraines and other neuropathic pain. It is especially useful for pain management in cancer patients. It’s even been found useful in long Covid.

However, while the promise of ketamine infusions in treating various health conditions is compelling, there remain significant challenges in their widespread adoption in South Africa.

Challenges with medical aid payments

One of the primary hurdles is the cost and payment of ketamine infusions. This treatment can be expensive, and patients often find themselves struggling to access it due to inadequate medical aid coverage. Ketamine can save costly admissions and long-term rehabilitation with a relatively cheaper outpatient community-oriented model, as is being explored in Soweto. Addressing this issue is crucial to ensure that this effective therapy is available to a broader spectrum of patients.

Governance and supervision

Another concern is the growing but poorly supervised use of ketamine. Ensuring that this powerful substance is administered safely and ethically is vital. Comprehensive practice guidelines and oversight are necessary to prevent misuse and potential harm.

In some measure, this was the reason for the death of “Friends” actor, Matthew Perry. He clearly found benefit, but his ketamine treatment appeared to be far too frequent with daily infusions over weeks in his rehabilitation centre. It can be psychologically addictive and he clearly was abusing it with tablets bought on the black market when he died.

It is sad but unfortunate that naysayers are using his death to say “see, I told you!” We are in the middle of a crisis of codeine and benzodiazepine abuse with medical practitioners doling these out without consideration of its potential for abuse and addiction. Many patients are not even aware of their addiction, having been on these for years. All psychoactive drugs require oversight and care.

The emerging role of ketamine infusions as a remedy for mental health issues is a promising development that could bring relief to those who have long suffered in silence. The growing evidence from recent systematic reviews underscores its potential value in addressing conditions such as depression, suicide, PTSD, substance abuse, and chronic pain.

Nevertheless, challenges, such as medical aid payment and governance, must be addressed to ensure that this treatment reaches those who need it most.

It is imperative that South African society continues to explore and harness the benefits of ketamine infusions while safeguarding the well-being of those seeking its therapeutic embrace. DM