Americans Take Ketamine at Home for Depression with Little Oversight

Generic ketamine is not approved for these conditions. Studies have shown can quickly relieve symptoms severe depression when other treatments have failed.

There is less data on effectiveness of ketamine for other conditions There is little data on long-term use, including anxiety and PTSD.

FDA approved chemically related version a drug called esketamine

Johnson and Johnson

for treatment-resistant depression with suicidal thoughts.

Clinics certified to administer J&J’s nasal spray should monitor patients for two hours afterwards.

People taking generic ketamine at home are not subject to the same supervision.

Mindbloom Inc., Nue Life Health PBC, and Wondermed LLC are among nearly a dozen companies currently selling ketamine tablets or lozenges online, enjoying relaxed restrictions on prescribing controlled substances during the pandemic.

Companies work with clinicians prescribing ketamine to patients based on a survey and virtual assessment. Generic ketamine pills or lozenges are mailed to patients’ homes. The companies say they instruct people to take the drug with someone nearby, among other safety measures.

Doctors said that taking ketamine at home without medical supervision puts patients at risk of falling and hurting themselves or taking the drug more than prescribed. Psychiatrists said that ketamine can be addictive and patients who have had a troubling experience while taking the drug may not get the help they need.

“Places that make virtual ketamine are a compromise between accessibility and safety,” said Dr. Benjamin Yudkoff, medical director of the ketamine and esketamine program at Brigham and Women’s Faulkner Hospital in Boston.

High doses of ketamine prescribed to some telehealth patients increase heart rate and blood pressure and increase the risk of rare complications such as stroke or heart attack, medical experts said.

“A drug like this has the potential to cause general anesthesia at home in a completely unsupervised setting,” he said. Michael Champeau, president of the American Association of Anesthesiologists.

The companies said prescribing ketamine-assisted therapy at home could help fill the need for people who don’t respond to current medications or who can’t reach or afford treatment in person. Ketamine blocks a receptor on brain cells that is important for brain adaptability; This could help facilitate changes in mood and mindset, the researchers say.

Mindbloom and Nue Life cited peer-reviewed research have published suggesting that many patients reported feeling better She reported several problems after taking ketamine and with taking the drug.

Mindbloom, Nue Life and Wondermed said they refuse to treat people whose symptoms are very severe or who have a history of conditions such as substance use disorder, psychosis or uncontrolled hypertension. Nue Life said she sometimes consults with a patient’s doctor before prescribing ketamine, and Mindbloom frequently requests medical records. Wondermed said patients may choose to have their doctor work with the company during treatment.

Nue Life tells patients to start at around 125 milligrams and prescribe a maximum of 750 milligrams for a dose. Wondermed says it prescribes patients between 100 milligrams and 400 milligrams for a dose. Mindbloom told patients it started at around 400 milligrams, with some patients graduating to doses around 1,000 milligrams.

Ari Aal, MD, a psychiatrist in Boulder, Colo., who prescribes lower doses of ketamine to patients taking it under supervision at her clinic, said doses of around 1,000 milligrams increase the risks for serious side effects, including rare seizures, hemorrhages or strokes.

Dr. said Aal.

Mindbloom and Wondermed said they provide blood pressure monitors for patients to use before and during treatment. Nue Life says it instructs patients with controlled hypertension to monitor their blood pressure.

Timothy Mitchell, a 40-year-old patient attorney from Ballston Lake, NY, said Mindbloom started him last year at a dose of 800 milligrams. He said he’s been following his third six-dose regimen with Mindbloom, which is 1,200 milligrams per dose. She said the treatment helped her quiet suicidal thoughts.

Wondermed says it charges $399 for a month of ketamine tablets or lozenges and a telemedicine treatment. Mindbloom said it charges about $1,000 for nearly three months of ketamine and telemedicine care. Nue Life said it charges up to $2,999 for four months of ketamine tablets and telemedicine treatment. Health insurers generally do not reimburse people for off-label treatments.

Amanda Itzkoff, psychiatrist and CEO of Curated Mental Health, which administers ketamine in clinics, said she declined to be on Mindbloom’s advisory board in part because she was concerned that home use might not involve adequate patient supervision.

In a comparison to the crackdown on psychedelic-drug research decades ago, he said, if companies carelessly prescribe ketamine for home use, they could delay the adoption of a valuable treatment. “We can blow it up again,” said Dr. said Itzkoff.

A spokesperson said Mindbloom’s Dr. Itzkoff and said he did not raise security concerns. Mindbloom’s medical director, Dr. Leonardo Vando said it’s critical for Mindbloom to strike the right balance between expanding access to ketamine and safe prescribing practices.

Courtney Gable, 47, said her husband checked on her when she took ketamine, which Mindbloom prescribed this year to treat chronic pain and depression. The 400 milligram dose was higher than the initial dose prescribed at a clinic in Philadelphia where she worked, she said.

“There is a safety net, but the gaps between the net are a bit wider,” he said. said Gable.

Los Angeles-based 32-year-old actor and video game model Leon New Valentine had Peak Health Global Inc. was prescribed 100 milligrams of ketamine online by and took the drug with someone nearby. Max. Using them as pronouns, Valentine said they graduated at the 150 milligram dose and took it alone. Ketamine relieved symptoms of treatment-resistant depression and PTSD, Mx. said Valentine.

Mx, “Things are cheering up again, even though I’m in pain”. said Valentine. Peak said it will close in November as it expects rules allowing remote prescribing of controlled substances to be tightened soon.

Write to Brianna Abbott at: brianna.abbott@wsj.com and Daniela Hernandez daniela.hernandez@wsj.com