“I hope we don’t end up on the wrong side of history on this.”
Psychiatrist in charge of patient care
NIH ketamine clinical trials
Opposition from Psychiatrists
You’d think psychiatrists would be thrilled at the prospect of a powerful new weapon against depression, bipolar, PTSD, and anxiety. Some are. Many are not.
The ketamine discovery shines a bright light on the biological underpinnings of depression, bipolar, and PTSD. The very fact that it works – fast – undermines the way many psychiatrists have viewed and treated these conditions for decades.
Entire psychiatric practices are built around “medication management”, where patients come in regularly so doctors can refill their psychotropic prescriptions and decide if their doses should be adjusted. Many of these practices don’t provide meaningful treatment at all – they simply write prescriptions and tweak doses, and bill for that service, without developing effective doctor/patient relationships. Doctors in this type of practice have no financial incentive to aggressively pursue all possible treatment options, or to discontinue a med even after the patient has been on it for years with no real benefit, possibly having developed a serious dependency problem. Of course not all psychiatrists fit this description, but many do. For severe treatment-resistant sufferers, ketamine therapy renders this business model obsolete. If ketamine therapy were widely adopted, it could fundamentally change the way many psychiatrists earn income.
Very few psychiatrists can perform ketamine infusions themselves. Most psychiatrists haven’t touched a patient since medical school. They don’t have the training, experience, or facilities to perform a technical procedure like an infusion. Some have teamed up with other medical professionals with the necessary skills to perform ketamine infusions, and of course they can always refer patients to outside specialists for the procedure. But some psychiatrists have expressed to us resentment about being excluded from this revolution, in terms of patient gratitude, and also revenue.
Many psychiatrists we talk to say they’ve heard about supposed depression breakthroughs before, but none of them panned out, so they’re not going to fall for this one. To us, that attitude demonstrates inexcusable intellectual laziness. It shows they’ve made a conscious choice to ignore new research from the very medical schools that trained them. When a doctor stops keeping current in his specialty and decides in advance that further scientific progress is impossible, he is guaranteed to miss it when it arrives, as will his patients. To those doctors who have already declared permanent defeat: try to keep up with your profession, please.
Change is always met with resistance. For psychiatrists, ketamine represents radical change. It’s not surprising that many oppose or willfully ignore ketamine therapy. As the number of successful ketamine patients grows, so will the resentment towards anti-ketamine psychiatrists, and the missed opportunities for relief they represent.
Psychiatry could play a vital role in ketamine therapy, if it chooses. Today, when ketamine patients get sudden relief, there is no medical guidance on how to capitalize on that relief. There are no psychotherapies or counseling programs designed to take advantage of ketamine’s effect. But there should be. Ketamine responders often say they are suddenly able to achieve rapid, profound emotional healing, and break out of negative behaviors and thought loops that were previously inescapable. Professional guidance could help them solidify these results into deep, lasting improvements. Today, these patients are mostly left to figure it out for themselves.
An NIH psychiatrist who cared for several of the Ketamine Advocacy Network founders during clinical trials once told them, “There is a ketamine tsunami coming, whether psychiatrists are ready for it or not. I hope we don’t end up on the wrong side of history on this.” We couldn’t agree more.