If you live in New York City, you’ve likely passed or heard of a clinic where ketamine — a hospital anesthetic and psychedelic party drug — is used as a mental health treatment.
Locations now operate in the Financial District and Brooklyn Heights. Walk up 5th Avenue and a New Yorker will encounter five clinics off this street alone.
No official tally exists, but the nonprofit American Society of Ketamine Physicians, Psychotherapists and Practitioners lists seven members as practicing in New York City and 24 members listed in New York state overall. This number likely represents a low estimate of clinics given a quick internet search reveals way more on Yelp.
According to U.S. surveys, people are increasingly seeking mental health services and becoming open to the idea of psychedelics to address those ailments. Ketamine clinics are where these ideas and wants meet. But while each space may claim to provide ketamine therapeutically, they can differ in approach, what they require of patients, vibes and safety.
Formally known as ketamine hydrochloride, the drug is a mixture of two mirror-image molecules, R-ketamine and S-ketamine. Scientists first synthesized ketamine in the 1960s, and during this time, they found the drug causes “dissociative anesthesia.” That means — along with numbing the body as an anesthetic, it also distorts senses and causes people to feel detached from reality.
These hallucinogenic effects explain why ketamine is often considered a psychedelic, and federal regulators classify it as a Schedule III drug, meaning it has a low to moderate potential for physical and psychological dependence.
The Food and Drug Administration has not approved ketamine for the treatment of any psychiatric disorder, but the agency sanctioned the drug as an anesthetic without restrictions back in 1970. That means the drug can be prescribed off-label — or for unapproved purposes.
A growing body of evidence and personal stories show the drug can help with conditions like treatment-resistant depression when taken intravenously, or via IVs. While it can take a few weeks to feel the full effects of standard antidepressants, ketamine can offer quick relief in just a few hours. But it can also be an expensive process complicated by a few unknowns.
But not all ketamine drugs and therapies offer the same effects or safety. On Oct.10, the FDA warned against using compounded versions of ketamine—variations of the drug like lozenges and tablets—especially while unsupervised at home.
This October alert has more to do with the boom of online prescribers dispensing ketamine that began in 2020 after pandemic-related telemedicine changes, than with the clinics offering off-label supervised intravenous infusions. In the alert, the FDA warns that patients who receive compounded ketamine products from telemedicine platforms may not receive information about potential risks. In turn, some working in ketamine clinics welcomed the FDA alert.
“The FDA guidance offers some real clarity in the field,” said Dr. Nico Grundmann, an emergency-medicine physician and the co-founder and the medical director of Ember Health. “There really is only one way of doing this in an evidence-based, data-backed way, which is office treatments through an IV. The guidelines, if anything, should help clarify that the other options people are seeing are not yet safe or supportive.”
If you’re a New Yorker considering ketamine for your mental health, here’s what to consider.
What is ketamine and what does it have to do with mental health?
Ketamine differs from most anesthetics because it doesn’t totally suppress brain activity. After its discovery in the 1960s, interest in ketamine as a psychiatric therapy came and went for a few decades, but blossomed in 2000 when a clinical trial found the drug caused rapid antidepressant effects. While it’s not exactly clear yet why ketamine seems to have this positive influence, animal studies on mice show the drug can increase the activity of newborn neurons and change neuronal activity patterns. Overall, this suggests ketamine supports new connections in the brain.
Because ketamine can relieve depression within hours, it’s emerged as an option for immediately treating people with suicidal feelings.
Dr. Michael Grunebaum is an associate professor of psychiatry at Columbia University Medical Center and a research psychiatrist at the New York State Psychiatric Institute. His research shows that ketamine can reduce suicidal ideation in people with depression, which is one of the most favorable aspects of the drug.
Another group who could benefit most from ketamine-assisted therapy are those with treatment-resistant depression, Grunebaum told Gothamist. Treatment-resistant depression is a type of major depressive disorder where people do not experience relief from antidepressant medications.