Many media stories about ketamine as a treatment for psychiatric disorders such as depression “go well beyond the evidence base” by exaggerating the efficacy, safety and longevity of the drug or by overstating the risks, an analysis has found.
Researchers examined 119 articles about ketamine and mental illness published by major print media in Australia, the US and UK over a five-year period. They found articles peaked in 2019, when the US Food and Drug Administration approved a ketamine-derived nasal spray known as esketamine for treatment-resistant depression.
Researchers found 37% of articles contained inaccurate information, largely related to efficacy, safety information and the longevity of the effect of the treatment. Ketamine treatment was portrayed in an “extremely positive light” in 69% of articles, the review found.
“Overly optimistic statements from medical professionals regarding efficacy or safety may encourage patients to seek treatments that may not be clinically appropriate,” says the paper, published on Thursday in the journal BJPsych Open.
“Disconcertingly, some articles included strong statements about treatment efficacy that went well beyond the evidence base. Conversely, exaggeration of the risks may discourage patients from pursuing a treatment that may be suitable for them.”
The president of the Royal Australian and New Zealand College of Psychiatrists, Dr Elizabeth Moore, said ketamine is a complex drug with strong mental and physical effects.
“It is not recommended as a first-line treatment,” she said.
“As an emerging treatment, there is currently limited guidance translating research findings into clinical practice.”
She said safely increasing access to new treatments was welcome, but there have been “legitimate concerns raised” about ketamine.
“Around the long-term efficacy, safety, tolerability, patient selection, risk for precipitating substance use disorder, as well as appropriate personnel and settings for competent and safe administration.”
Clinical studies show a dose of ketamine treatment does help people with serious clinical depression to rapidly feel better, but this effect usually lasts just a few days. Many psychiatric disorders are chronic.
The effects of the long-term, repeated use of ketamine treatments need to be more comprehensively studied, and researchers have called for better monitoring and reporting of ketamine-related side effects.
The lead author of the new study, the University of Sydney’s Nicollette Thornton, said there has also been similarly overexaggerated media reporting around the use of psychedelics for treating mental illness.
“It’s really important to note that our research isn’t about how effective ketamine is or whether it works,” Thronton said. “It’s about whether reporting of it is occurring in a balanced and accurate way.
“We’ve now got psychedelic substances such as psilocybin and MDMA being reported in media articles similarly, where they are being described as wonder drugs. But it’s really important that reports contextualise the limitations of these drugs and treatments, and differentiate between anecdotal patient or doctor reports and evidence.”
Prof Ian Hickie, co-director of health and policy at the University of Sydney’s Brain and Mind Centre, is part of a research team studying the long-term results for patients using esketamine for treatment-resistant depression.
Hickie said ketamine, an anaesthetic, has been more comprehensively researched for use in psychiatric disorders than many of the psychedelic substances currently generating hype.
He said depression can be a life-threatening illness for many people, so the idea of advances are likely to generate excitement.
“What sits behind the hype is that the problem of treatment-resistant depression is a serious one,” Hickie said.
“The problem is results for most treatments drop off when you move from clinical trials and into real world, widespread use. No treatment fixes everybody and depression is a very broad church.
“Only one-third of people respond to the first-line treatments for depression. The question is, what alternatives should those other people have access to, especially when it comes to new, novel and more expensive treatments?”
