A ketamine expert has predicted that NHS trusts will start using the drug and other psychedelics to combat depression after it was endorsed by psychiatrists.
Professor David Nutt, from Imperial College London, told Metro that the class B drug could be injected into patients or sprayed into their noses if they’ve not found other forms of treatment have worked for them.
He said that he wouldn’t be surprised if other drugs, such as magic mushrooms, could also be available on the NHS for other treatment soon.
It comes after The Royal College of Psychiatrists said it would ‘recommend the use of ketamine in specialist settings with appropriate oversight and long-term monitoring arrangements.’
But it added that further research is needed on other psychedelic drugs.
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Current treatments for depression on the NHS include counselling, Cognitive behavioural therapy (CBT) and antidepressant medication.
Prof Nutt told Metro: ‘The Royal College of Psychiatrists’ decision is about time. We’ve known ketamine is a useful treatment for depression for 20 years.
‘We know it works but there has been such hostility to it. The UK has lagged behind but now we are moving in the right direction.’
The professor is a fellow of the Royal College of Psychiatrists and has been researching ketamine for over thirty years.
While the drug is not a licensed treatment for depression, it is already used ‘off-label’ by a small number of NHS and private clinics in the UK.
Prof Nutt explained to Metro how ketamine treatment would work on the NHS and why it could be used to combat other mental health conditions.
Why can ketamine treat depression?
Ketamine’s psychedelic properties can help break negative thought processes faced by people with depression.
Prof Nutt explained: ‘Depression is a disorder in which people get locked into thought processes which are wrong.
‘Even though they know logically that is wrong, they can’t stop those thoughts.
‘Ketamine disrupts the brain. When you take ketamine for an hour or two, you have a powerful disruption of that thinking, and that allows people to escape from the thinking for a period.
‘More than that, their brain is in a state where they can continue to think differently and continue to think more positively about themselves.
‘It gets you our of depression and puts your brain in a state where you can stay out of depression.’
This positive effect can last for years, he added, but for others it might come back, requiring additional top ups of ketamine.
Nutt says ketamine can also be used to treat a range of psychiatric disorders such as OCD, anorexia and addiction.
How could ketamine be used on the NHS?
Although ketamine is not a licensed antidepressant, it is used ‘off-label’ by private clinics and a handful of NHS clinics.
Ketamine, which is a licensed anaesthetic drug, is only employed for patients when other treatments for depression have failed.
One method for treatment with ketamine would be injections of the drug into a patient at a clinic, with a psychiatrist and nurse on hand.
Prof Nutt said: ‘They would have one or two or three ketamine sessions. Maybe one session every week. If their mood lifts then often their mood stays lifted for months.
‘Ideally it takes two or three sessions with therapy. It is not the same as traditional medicine.’
The treatment would send give patients a psychedelic trip-like experience in order to rework their though patterns.
‘It is not an anaesthetic dose, but it is psychoactive. People do have an altered consciousness and a psychedelic-like experience,’ Prof Nutt explained.
‘They feel very different and can often have experiences of going back to childhood and trauma and a deep inner experience.
‘After an hour of that, they come out and then you can use those experiences to build their therapy.’
A different form of treatment involves a drug derived from ketamine – a nasal spray known as esketamine or Spravato.
(Credits: via ZUMA Press Wire/Shutterstock)
This is already licensed in the UK for treatment-resistant depression, but is not available on the NHS in England.
This spray is still taken in a clinic and not at home, and is used alongside conventional treatment of depression.
The ketamine expert says although it has been approved by the NHS in Scotland it has never been used.
Is ketamine safe?
Despite being a common recreational drug, ketamine is ‘very safe’, Nutt says.
The drug is classed as a schedule 2 medicine, alongside morphine, cocaine and others, which means doctors can prescribe them.
Prof Nutt said: ‘Ketamine is very safe. You can’t overdose on ketamine. The fact it’s used recreationally shouldn’t deter us from using it for patients.
‘Morphine is way more dangerous because in overdose, morphine will kill you. Yet doctors use morphine all the time in surgical practice.’
Esketamine, the derivative of ketamine, has been approved for use in a number of countries, including the FDA and Australia.
Ketamine is currently a Class B drug, but the government is reviewing whether it could be bumped up to Class A.
Is ketamine already used by healthcare providers in the UK?
The class B drug is already used by around 20 to 30 private clinics, Prof Nutt says.
He added: ‘There’s quite a lot in the private sector because it works. The NHS has been reluctant to adopt it.
Only a small handful of ketamine clinics are being run via the NHS, such as at the Interventional Psychiatry Service in the Oxford Health NHS Foundation Trust (OHFT).
The OHFT says on their website that patients who live in Oxfordshire or Buckinghamshire who are referred by an OHFT consultant may be able to have treatment ‘on the NHS’.
How could the Royal College of Psychiatrists’ decision change treatment for mental health conditions?
The Royal College of Psychiatrists’ announcement could help encourage other NHS Trusts to begin using ketamine for treating depression, Prof Nutt predicts.
He has pointed to a pilot ketamine clinic which has been set up at St Charles Hospital in London.
Their work is ‘building up an interest group of psychiatrists across the UK who want to work using that model,’ he said.
He added: ‘In a few months we’ll have the outcome from this pilot site. If it turns out to be as effective as we have seen it being in private practice, then I think the NHS will start to set up these similar centres in other hospitals.’
The Royal College of Psychiatrists fellow predicts there will be at least 10 NHS Trusts in Britain running ketamine clinics within two years.
‘Every major psychiatric hospital should have ketamine clinics,’ he says.
Could other psychedelic drugs be used in the UK?
The Royal College of Psychiatrists stressed that further research is needed on other psychedelic drugs before they are used to treat mental health conditions.
The Australian government has already approved the use of MDMA and psilocybin – a naturally occurring psychedelic compound found in certain mushrooms – for clinical use.
Canada and Israel also allow the use of psychedelics compassionately.
Studies in the UK are looking at use of LSD to treat a wide range of conditions, such as substance abuse, anxiety and depression.
Nutt says he would prefer the use of psilocybin, commonly known as magic mushrooms, over ketamine.
‘Our work in Imperial College has shown that psilocybin is even more powerful than ketamine,’ he explained.
Both psilocybin and LSD are schedule 1 drugs, which means they cannot be legally prescribed to patients.
He is calling for those drugs to also be made a schedule 2 medicine, like ketamine.
Nuff predicts that will happen and that the drug will soon be used by doctors to treat mental health conditions.
He said: ‘Within a few years, psilocybin and possibly other psychedelics will be medicines for people with severe mental illness if they haven’t responded to the current medicines.’
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