Inside Field Trip Health’s New York City clinic, the vibe is less doctor’s office, more tranquil spa.
Tucked away on the 11th floor of a nondescript building, you can barely hear the clamor of the busy streets. Instead, this ketamine clinic feels like an oasis of zen, strewn with twinkle lights, lush greenery and comfy meditation pillows.
That vibe is part of what attracted Chere Scythes, 51, to come back on a chilly Thursday night for another ketamine treatment.
“A few of my friends and colleagues had tried ketamine and other types of psychedelic treatments,” Scythes said. “And in talking to them, the stories were hard to believe. But they’re people I knew for 20 years, and they seemed like different people. They had that big of a change.”
Scythes said she first sought ketamine therapy last winter, when she realized that a series of traumatic events, including the death of her mother from alcohol abuse, a divorce and, more recently, the loss of her best friend, were taking a toll. Over the years, she said, she had tried antidepressants, but they didn’t work for her. Meditation and therapy helped but didn’t do enough.
“I realized after some time off from work and meditating quite a lot that I just had this deep sadness in me and this anxiety in my chest,” she said.
Ketamine is a hallucinogen that has been approved by the Food and Drug Administration as an anesthetic for decades, but it is also used illegally as a party drug. Over the last few years, growing research has found that the drug also works for treatment-resistant depression in some people, which led the FDA to approve a version called esketamine, or Spravato, in 2019. It’s an inhaled version that must be administered in a doctor’s office, and it is approved only for people for whom other treatments have failed.
But in recent years — even before the approval of Spravato — a new industry has emerged: ketamine clinics, which offer the drug off-label as either an infusion or an injection for a wide variety of mental health problems. “Off label” use means the drug hasn’t been specifically approved for those conditions.
At Field Trip, a national chain of clinics that has offered ketamine-assisted psychotherapy for several mental health conditions since 2019, patients first undergo a screening to see if they qualify for treatment. If so, patients get shots of ketamine while they lounge wearing eye masks as clinicians lead them through guided meditation. They also meet with therapists before and after their “trips.”
“Patients say, ‘This changed my life,’” said Mike Dow, a psychotherapist at a Field Trip clinic in Los Angeles.
It’s unclear how ketamine works precisely in the brain. Dow said he believes it may boost feel-good chemicals, similar to traditional antidepressants, as well as reduce inflammation, and form new neural pathways that are associated with the ability to create new habits and behaviors.
People also undergo psychedelic experiences that can feel spiritual, which in itself can boost their mood, Dow said.
But as the number of new ketamine clinics skyrockets, with centers springing up across the country, some doctors are worried that it’s an unregulated industry that’s ripe for danger.
Because the drug has FDA approval, any doctor can prescribe it off-label. Clinics aren’t regulated federally, but they are subject to the same state laws as other outpatient medical clinics.
“The concern with these clinics’ popping up is that people are getting treatments that haven’t been well-proven, well-studied or following any guidelines,” said Dr. Smita Das, an associate professor at Stanford University School of Medicine and chairwoman of the American Psychiatric Association’s Council on Addiction Psychiatry. “My concern is that people who need treatment will spend their money and energy in these ketamine clinics that aren’t well-proven.”
Treatments can be expensive — from $400 to $800 a session, on average, said Kathryn Walker, the CEO of Revitalist, a chain of clinics that offers ketamine infusions — and they aren’t covered by insurance.
There can also be side effects, including changes in mood and blood pressure, as well as nausea and drowsiness.
Das and Dow say they’re also concerned that some clinics may be offering the drug without any supervision, which is especially worrying if a patient has a “bad trip.”
Only a few small studies have looked at its benefits for other mental health conditions beyond treatment-resistant depression, and the American Psychiatric Association doesn’t provide specific guidelines for its use.
“People can rarely experience paranoia or suicidal ideation,” Das said. “And so many of these clinics don’t have mental health professionals staffing them. When those mental health concerns pop up, they may not be equipped to respond appropriately.”
Ketamine also isn’t a cure-all. Not everyone responds to treatment, and it can stop working in some people, said Dr. Subhdeep Virk, the director of the Treatment-Resistant Depression Program at Ohio State University Wexner Medical Center.
“It’s very hard to predict who is going to respond and how long it’s going to last,” said Virk, who has been treating patients with ketamine since 2018. She added that it’s also unclear whether the drug can help conditions besides treatment-resistant depression.
Lynette Ebberts, 66, said that for her, ketamine was a lifeline. For nearly 40 years, she said, she tried dozens of combinations of antidepressants, electroconvulsive therapy and other treatments for her severe depression, but nothing worked.
In 2016, before most people had heard about ketamine for depression, her therapist recommended a clinic near where she lived in Raleigh, North Carolina.
“I said, ‘Yes, when and where?’” she said. “I was so desperate to feel better. I thought trying something is better than not trying anything at all and end up taking my own life.”
Ebberts said each 45-minute infusion felt like a dream, in which she saw vibrant colors and shapes. After she underwent three treatments in one week, she said, something started to shift.
“I started to feel like I could get up out of bed,” she said. “That deep dark depressive cloud started to lift.”
In combination with her antidepressants, she has continued the ketamine treatments and now gets one every five weeks.
Unlike Ebberts, Scythes doesn’t return to the clinic regularly.
She vividly remembers her first treatment. She saw herself as a little girl, playing in the woods that she loved as a child, and then she saw her mother, who passed away nearly 20 years ago.
“I told her how much I loved her and how much I missed her, and I felt this unconditional love for her that I couldn’t quite feel when she was alive,” she said. “Once it was over, that deep sadness that was in my body for so long was just gone.”