Research by Dr. Thomas Swahn
Barriers to Using Ketamine for the Treatment of Depression
Depressive disorders are prevalent in the United States. Current treatment paradigms take weeks to reach clinical efficacy and may leave patients at risk for suicide during the initial weeks of treatment. Intravenous (IV) ketamine infusions have shown promise in the rapid relief of depression symptoms, including efficacy in treatment-resistant depression and relief of suicidal ideation. Initial research has shown ketamine therapy to be safe and effective. Despite a plethora of information in support of the safety and efficacy of ketamine, there is reluctance of both patient and provider in utilizing ketamine’s unique potential. We used a grounded-theory approach to perform a meta-analysis literature review exploring the barriers preventing widespread acceptance of ketamine therapy. We found fear or moral objection to psychoactive effects, potential side effects, and history of abuse as a street drug to be inhibiting factors among patients. Among healthcare providers, barriers included lack of accessibility, addictiveness, abuse potential, and refusal of insurance policies to cover treatment. We present arguments to challenge objections and question concerns as the vast benefit of ketamine therapy far outweighs potential harms. We give recommendations for further research and call for a more rational approach to U.S. drug policy with a focus on objective evidence and an elimination of unwarranted restriction of personal freedoms.
Ketamine Therapy Educational Presentation (Length: 9:44)
Effect of Education on Perception of Ketamine in Primary Care and Mental Health Providers
Background: Mental illness is a major healthcare problem. Depression is the leading cause of premature death and disability among adults aged 18-44 worldwide. In the United States, 21% of adults are afflicted by a mental illness. Ketamine therapy is a promising treatment for many mood disorders including treatment-resistant depression, yet is underutilized in US healthcare. Purpose: This project aimed to explore the perspectives of primary care providers and mental health providers toward ketamine therapy. Implementation: Surveys and an educational presentation were developed to identify providers’ perspectives of ketamine therapy before and after education. These were distributed to primary care practices and mental health practices from the 84015 ZIP code and surrounding areas. The surveys included open-ended qualitative questions and quantitative questions using Likert scales to evaluate views. Results: A small number of providers participated, limiting generalizability of results. Statistical analysis was performed to evaluate changes in quantitative responses, finding an increased rating of familiarity with ketamine and its psychoactive effects, as well as increased perception of safety, though there was a decreased likelihood to recommend ketamine therapy for patients or to utilize for themselves or loved ones among medical providers. Qualitative analysis was done in an iterative review revealing themes associated with ketamine in participants perspectives, with medical terminology comprising the bulk of initial perspectives and shifting post-education responses toward different themes. Discussion: The findings of this study suggest that medical providers may be less inclined to recommend ketamine therapy after education discussing its psychoactive effects despite evidence of its efficacy, whereas mental health providers show much more openness to both aspects. Future research should aim to clarify factors influencing this discrepancy and to develop more effective educational approaches.