The drumbeat for ketamine as a way to halt the rising suicide rate is upon us, as the New York Times has now joined the chorus. This is encouraging news unless of course you recall a couple of things: how recent enthusiasm from the medical-industrial complex for increased opioid use for pain resulted in the current opioid epidemic; and how the NYT has joined other notorious choruses such as Ahmed Chalabi’s one that sang about WMDs in Iraq.
On November 30, 2018, the NYT published a lengthy op-ed “Can We Stop Suicides?” in which Moises Velasquez-Manoff offers this solution: “an old anesthetic called ketamine that, at low doses, can halt suicidal thoughts almost immediately.”
Similarly, in July 2017, Time magazine (“New Hope for Depression”) announced: “The biggest development has been the rediscovery of a promising, yet fraught, drug called ketamine. It’s best known as a psychedelic club drug that makes people hallucinate, but it may also have the ability to ease depression— and fast.”
Drug companies are pushing for Food and Drug Administration approval of their ketamine-based products for depression. Ketamine, although not currently FDA approved for depression, can be prescribed “off-label” for it. Ketamine is most commonly classified as a “dissociative anesthetic,” and its adverse effects include numbness, depression, amnesia, hallucinations, and potentially fatal respiratory problems. Termed “Special K” on the streets, at high doses, ketamine users experience an effect referred to as “K-Hole,” an out-of-body experience. Since the ketamine user can find it difficult to move, it has been used as a date-rape drug.
Velasquez-Manoff does offer some caveats about the lack of definitive research on ketamine’s safety and effectiveness as a treatment for depression (STAT reported in September 2018 that there is simply no data on ketamine’s long-term effects and potential risks). However, the bulk of Velasquez-Manoff’s NYT piece— which includes an extensive anecdotal testimonial that concludes with “It really is a godsend— is an argument for ketamine to be prescribed more.
While drug companies, psychiatry, and some in the media are currently excited about ketamine being used in lower doses for depression, keep in mind that this drug is by no means the first “promising new depression medication” in the history of psychiatry that turned out to promise far more than it delivered—or to be a disaster.
Sigmund Freud, as a depressed young man, started using cocaine and cheerfully proclaimed, “I am just now busy collecting the literature for a song of praise to this magical substance. . . . You perceive an increase of self-control and possess more vitality and capacity for work. . . . Absolutely no craving for the further use of cocaine appears after the first, or even after repeated taking of the drug.” Later, Freud was embarrassed by his celebration of cocaine.
Beginning in the late 1980s, the “miracle antidepressants” were the selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Paxil, and Zoloft. Psychiatry authorities and pharmaceutical companies told the general public that depression is caused by a “chemical imbalance” of low-levels of serotonin that could be treated with these SSRI chemically-balancing antidepressants.
Today, the falseness of this chemical-imbalance theory of depression is not controversial. In 2011, psychiatrist Ronald Pies, editor-in-chief emeritus of Psychiatric Times, stated, “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend— never a theory seriously propounded by well-informed psychiatrists.”
After discovering that the chemical imbalance theory was untrue, National Public Radio correspondent Alix Spiegel, in 2012, sought to unearth authorities’ justifications for promulgating it. One such rationalization was that by framing depression as a chemical deficiency, patients felt more comfortable taking antidepressant drugs. While some psychiatrists view the chemical imbalance theory as a well-meaning “white lie,” my experience is that, even today, many physicians continue to be unaware of the truth.
Velasquez-Manoff reports that the current crop of antidepressants that include SSRIs can “increase suicidality in some patients,” and this is accurate. For several years, scientists have known that SSRIs are far less safe and far less effective than initially proclaimed, and now promoters of ketamine are publicizing the failings of SSRIs. In the history of depression medications, it is often only when a newer drug is being promoted that the general public hears about the failings of older treatments.
“The suicide rate has been rising in the United States since the beginning of the century,” notes Velasquez-Manoff.” This increase in the rate of suicide is occurring at the same time as increasing numbers of people are being psychiatrically treated with antidepressants. While correlation does not necessarily mean causation, this association should compel us to at least ask if increasing psychiatric treatment is doing any good.
Psychiatry has a track record of enthusiasm over new antidepressant drugs for which there is insufficient research to merit such enthusiasm. It also has a history of asserting theories of mental illness as if fact when no such facts exist to substantiate these theories. When confronted with their rap sheet, psychiatry repeats the same defense: “We’re a young science.” How many times does an authority get to be badly wrong before it loses its legitimacy as an authority?
It is often difficult for a society to challenge the legitimacy of its major authorities. U.S. presidents are rarely impeached, but when Americans are embarrassed enough, Congress has impeached or threatened impeachment compelling resignation (as was the case with Richard Nixon). Americans have even admitted that an Amendment to the Constitution was a bad idea and repealed it (the 18thAmendment, which created alcohol prohibition). And Americans ultimately agreed that the House on Un-American Activities Committee was an illegitimate authority.
There will always be illegitimate authorities in any society, and in a genuine democracy, these are ultimately questioned, challenged, and abolished. In a truly democratic society, one that is not a theocracy, there should be no authority that cannot be questioned. Blind faith in authority is the stuff offascism and religion.
As the New York Times reported in 2011 (“Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy”), the vast majority of psychiatrists are solely drug prescribers, so psychiatry as an institution is financially incentivized to look only for better drugs. My profession of clinical psychology mostly provides psychotherapy, and so we psychologists are financially incentivized to promote the superiority of talk therapy. Journalists should recognize that while some individual practitioners transcend financial incentives, professional guilds do not.
A suicide attempt is routinely fueled by overwhelming pain and a belief that this pain is a permanent condition. In some instances— such as terminal and inoperable medical conditions— that hopelessness may be a reality. However, often overwhelming pain that is subjectively experienced as permanent is actually a temporary condition— as is the case with a relationship breakup or the loss of a job; and so with genuine community, support, and love, emotional pain can be reduced, hope can be restored, and suicidal impulses are less likely to result in suicide attempts.
In a free society, people should be able to choose drugs to dampen their overwhelming pain, but in a sane free society, people should be provided with informed choice. A legitimate authority would not promulgate false theories as facts so as to get patients to take a drug, and a legitimate authority would be honest about drug adverse effects.
While some dissident healthcare professionals, ex-patients, and journalists blame antidepressants for causing increasing suicide, perhaps an even more significant cause of rising suicide rates is the consequence of completely medicalizing suicide. Specifically, a society that relies totally on medicine to fix suicide is one that has abdicated power to transform itself into a more humane society that does not breed suicide. The increasing medicalization of suicide enables a society to relinquish responsibility for creating genuinely caring communities.
A legitimate mental health authority would make great efforts to publicize the fact that suicide is highly related to social variables that create pain (for example, unemployment and poverty). A legitimate mental health authority would make clear that the most powerful solution to the U.S. suicide epidemic is not more treatment but a completely different culture and society: one with far fewer people who are totally isolated and alienated, and one where people would have the time to offer genuine compassion.
Some psychiatry critics come off as drug prohibitionists who antidepressant users experience as “pill shamers” lacking compassion. Many Americans feel that they are living in an insane and loveless society, and an increasing number of depressed Americans feel that the only options available to blunt their overwhelming pains are pills. In such a hellish society, a legitimate authority would not shame people for their choice to use a pill but instead would counsel the practice of “harm avoidance”: the least dangerous drug use.
History tells us that any drug that can dampen emotional pain— whether it is called a “drug” or a “medication”— will always have serious adverse effects. We now have an opioid epidemic in the United States for which much of the blame falls on medicine, the failure of regulatory institutions, and pharmaceutical companies. That ketamine is highly dangerous is uncontroversial, and while desperate Americans are vulnerable to believing an authority’s claims that ketamine can be used safely in low doses, a real journalist should be asking this question: Has psychiatry established the track required for such a claim to be trusted?