A growing number of private clinics are offering ketamine for depression, according to experts who warn of a potential “wild west” of providers with no national register of patients’ treatment being integrated into overall NHS care.
At least six private providers in the UK offer the drug for depression. In March the first service that also includes psychotherapy opened in Bristol, charging £6,000 for a course of low-dose treatments and talking therapy.
But health experts expressed concern about creating a two-tier system in which the novel treatment is unavailable to NHS patients. They also warned of “doctor shopping”, where patients go to a ketamine clinic one day and another the next without health professionals being able to keep track of who is getting the drug.
Scientists said the NHS healthcare watchdog was taking too long to update its guidance informing clinical practice on prescribing antidepressants in the UK. It was last updated in 2009.
Ketamine has a reputation as a party drug because of its short-term dissociative effects but is licensed as an anaesthetic. When abused, the drug can cause long-term problems such as ulcers, pain in the bladder and kidney problems. But it has shown potential in depression treatment trials for those who are resistant to other treatments.
Because ketamine is licensed to be used by doctors as an anaesthetic it can be prescribed off-licence for depression, which is what is happening in private clinics. To be prescribed on the NHS, it would need to be approved by the National Institute for Health and Care Excellence (Nice) as a cost-effective treatment.
Between 10% and 30% of people with depression do not respond to at least two drug treatments, equivalent to about 2.7 million people in the UK.
Prof Allan Young, the clinical academic lead in the psychological medicine and integrated care clinical academic group at the South London and Maudsley NHS Ttrust, said: “If it is being done privately, a big question is how is it integrated into their overall care. The model in this country is GP and then secondary care. Nevertheless, you could potentially go and get ketamine and your GP does not know about it and has no referral to psychiatric services.