Ketamine treatment evolves as regulators catch up

Dr.

Benjamin Brody, an inpatient psychiatrist at Cornell, built one of the earliest hospital-based ketamine treatment programs and now directs it. He explained how he secured approval to use ketamine, originally an overlooked anesthetic, for inpatient treatment, noting the differences in regulation between generic ketamine and esketamine, which requires a more controlled pathway. As synthetic psilocybin nears potential FDA approval, clinicians are grappling with questions about patient safety, staffing, informed consent, and insurance coverage. Dr.

Brody’s team identified a “dysphoric dissociation”, a rare, frightening reaction to ketamine distinct from a typical psychedelic “bad trip”, and gave it a name to better inform patients. He expressed concern about the growing practice of prescribing take-home ketamine via telehealth, citing risks of self-escalation and potential for fatal overdose. He also discussed the challenges of defining the clinician’s role in administering these treatments, especially regarding the length of sessions and the need for adequate staffing. Dr.

Brody highlighted the need to balance the neurotrophic benefits of ketamine at therapeutic doses with its neurotoxic potential at higher doses, warning about bladder damage from excessive use. He is currently advising his hospital system on implementing these treatments, considering factors like cost, monitoring requirements, and long-term patient outcomes. Despite the complexities, he remains optimistic about the potential of these new treatments to reach patients previously untreatable with standard antidepressants.