Exploring Psychedelics to Treat Mental Health Issues

Ketamine for Pain Management

De La Hoz discussed the uses of ketamine therapy for pain management. He notes that the opioid epidemic has left many people struggling with addiction. As a result, clinicians have been searching for less addictive methods to treat patients.

The Threat of Opioids

According to the CDC, 75% of drug overdoses in 2022 involved an opioid. Additionally, the NIDA states that between 21% and 29% of people prescribed opioids for pain management will abuse them.  

“Unfortunately, the promise from pharmaceutical companies about opiates — that they were not addictive and that they were the solution — was not true,” stated De La Hoz. “These medications did not live up to the hype and left a huge problem to address.”

While De La Hoz, like many other clinicians, criticizes opioids and opioid prescription due to their addictive properties, he notes that certain conditions may benefit significantly from the use of an opioid.

“Opiates have excellent indications in certain conditions: mainly acute pain after surgery, cancer pain, and end-of-life pain,” he explained. “Now, for back pain, or neck pain, or all similar conditions, we know that this is a biomechanical problem a lot of times. Clinicians must focus on physical therapy, rehabilitation, and good nutrition for those conditions. Again, taking this holistic approach and not only managing the pain but also providing a healing treatment for the patient.”

The Basics of Ketamine for Pain Management

PharmaNewsIntelligence asked De La Hoz to explain how ketamine works to manage pain. He stated that “ketamine was developed in the 1960s, and it was FDA approved in 1970, mainly as an anesthetic. It is what we call the dissociative agent.”

De La Hoz explains that the early uses of ketamine were just as an anesthetic. It wasn’t until later that clinicians saw how well it managed pain.

“Patients that received ketamine needed fewer pain medications. And it wasn't always only opiates; the need for pain medications generally decreased. Ketamine antagonizes the NMDA receptors in the brain, which are part of the glutamatergic system,” explained De La Hoz. This process helps reduce feelings of pain.

Ketamine for Treating Mental Health

Beyond its benefits for pain management, ketamine is also exceptionally good at treating mental health issues.

History of Antidepressants

“Traditional antidepressants work on amine neurotransmitters such as serotonin, dopamine, or epinephrine,” stated De La Hoz. He continued to explain that previous theories assumed that people with depression lacked these neurotransmitters and that the only way to treat depression was to increase the levels of neurotransmitters.

However, as the use of antidepressants is studied, researchers are skeptical about the accuracy of these theories. “Clinicians have found that this theory is not very accurate, and unfortunately, we do not measure serotonin levels when we place patients on antidepressants. Research shows that one-third of the patients placed on antidepressants have successful responses. In another third, there's a partial response, and in the last third, there's no response,” stated De La Hoz.

Psychedelics in Psychiatric Care

After explaining the issues associated with traditional antidepressants, De La Hoz began to describe the use of psychedelics, such as ketamine, to treat mental health issues. “As you know, recently, there's been a rebirth of psychedelics,” began De La Hoz. “There's strong data out there that psychedelics help with depression, anxiety, PTSD, and mental health conditions.”

De La Hoz explained that ketamine is currently the only legal psychedelic medication. He notes, “ketamine connects the frontal cortex, where humans form thoughts, with the limbic system, where we have emotions. It creates this connection between the unconscious and the conscious mind.”

According to De La Hoz, patients undergoing ketamine therapy see results almost immediately. “Researchers were treating patients that were suicidal, and they received ketamine, and they stopped having any suicidal ideations,” he revealed. “Healthcare professionals started doing more formal research and transitioned from using ketamine only as an anesthetic to the potential of using it for mental health.”

De La Hoz notes that studies have combined ketamine therapy with Lexapro. For patients just receiving Lexapro, the response time was approximately 25 days. Combined with ketamine therapy, the response time dropped to 6 days.

“Ketamine decreases the amount of time it takes for antidepressants to work. This is essential because the first few weeks is when patients have an increased risk of suicide or suicidal ideation,” commented De La Hoz. “Providers want to decrease that risk as much as possible. And by adding, or combining the two therapies, we can breach the therapy and get a faster response from these patients, which is incredible.”

He clarified that this does not mean that providers should altogether forgo antidepressants, but having alternatives is critical to ensure that all patients are receiving the appropriate treatment.

“Providers have a toolbox, and we must reach for appropriate tools for every patient. Unfortunately, when we see depression, many physicians try to treat the symptoms, but the reality is that these symptoms arise because of a root problem,” insisted De La Hoz.

Ketamine Administration Process

While De La Hoz advocates using ketamine to address mental health concerns, he does caution that this kind of therapy should be done in a controlled environment under the supervision of a medical professional. PharmaNewsIntelligence asked him to describe the process of enrolling in ketamine therapy at his clinic.

He explained that after a patient is referred to or seeks ketamine therapy, they undergo a medical evaluation. “Ketamine is a very safe medication. There are only a few control indications, mainly cardiovascular conditions. Once we determine that the patient is a good candidate, in our facility, they meet with the psychotherapist for cognitive behavioral therapy,” explained De La Hoz

On average, patients undergo six sessions; however, the number of infusions varies based on the patient and their situation.

He also shared the three factors impacting the response to ketamine: mindset, location or setting, and dose. Mindset refers to the patient’s willingness to undergo treatment. De La Hoz notes that the patient’s situation and why they are in it can drive treatment success or failure.

In addition, he notes that the setting is an important factor. “It's not the same as recreationally using ketamine. In our clinic’s controlled setting, we make it an introspective experience because we block all sensory input, the patients receive headphones, and they have an eye mask,” stated De La Hoz.

The third factor is the dose of ketamine. De La Hoz states, “there are doses that have been proven to be therapeutic after clinical trials and much research. It is an infusion because that's where we have most of the research and the data that shows us that that's the method that is proven to be beneficial. That doesn't mean that other methods of delivery are not beneficial. We just don't have that data right now.”

“There are some companies out there prescribing or sending ketamine at home via oral, via a pill. We do not advocate for that. We think that that makes ketamine available and has the potential for abuse. It is a medication that needs to be given under medical supervision.”

Looking Ahead

Because De La Hoz and his colleagues are holistic clinicians, their goals are to address more than the symptoms. Throughout his conversation with PharmaNewsIntelligence, he reiterated the need to combine ketamine therapy with nutrition counseling and cognitive behavioral therapy to maximize the full treatment benefit.

“We would like to see ketamine and psychedelics become more mainstream. We think there are valuable tools for patients suffering from depression who haven't found alternatives. We want to be leaders and guide other doctors trying to find options for antidepressants or to find different solutions for patients. And we also hope to see a lot of research into psychedelics so that we can have more data on how these treatments can impact mental health issues in the long term and, in general, how patients will respond to ketamine,” concluded De La Hoz.