March 19, 2024

expert reaction to comments by Elon Musk about use of ketamine for depression

Scientists react to Elon Musk claiming that he used ketamine for depression. 

Dr Rupert McShane, Consultant Psychiatrist at Oxford Health NHS Trust and Associate Professor at Department of Psychiatry, University of Oxford., said:

“It is helpful that Elon Musk has emphasised that ketamine should only be taken under medical supervision. People who try to treat themselves without medical help tend to take more ketamine (ie higher doses and more frequently) than if they were being prescribed it medically.  Medical use also assures the quality of the medicine.

“Using ketamine as the first alternative instead of an SSRI is not something I would recommend.  We know that when people stop taking ketamine or SSRIs there is an increased risk of relapse.  The risks of long term ketamine include tolerance, which depends on the dose and how frequently it is taken.  The risks of long term SSRIs are better understood.

“It is really important that we start tracking the benefits and side effects people get when they take long term ketamine. However, setting up tracking systems is expensive. Of note, the only one that currently exists is run by a university in Australia.  It is funded by a philanthropist.” 

Dr Paul Keedwell, Consultant Psychiatrist and Fellow of the Royal College of Psychiatrists, said:

“Ketamine is a fast and effective treatment for many people with depression but it should be given in a reputable centre. There are pros and cons compared with SSRIs. The main pro is that it works so quickly (within hours, compared with up to 4 weeks for SSRIs), and it avoids some of the side effects associated with SSRIs (like indigestion, weight gain, sexual dysfunction and reduced emotional range). The downsides are that ketamine is less convenient, and its antidepressant effects are temporary, necessitating frequent repeat treatments. 

“Stopping and starting ketamine treatment is not suitable for most people, who don’t experience the brief recurrent depression described by Musk. Judging whether to stop it after some months, or continue with long term treatment, depends on the history of your depression, as with SSRIs. In the U.K., it is mostly an option for people with treatment resistant depression that has been going on for years. 

“Ketamine is given in various forms, including a slow infusion into the vein, subcutaneous or intramuscular injections, an oral liquid or a nasal spray. 

“Access to ketamine treatment is limited in the U.K. Only the nasal spray is licensed, and this is restricted to Scotland. Elsewhere in the U.K. access to the treatment is limited to research centres and private clinics.” 

Prof Celia Morgan, Professor of Psychopharmacology, University of Exeter, said:

“A form of ketamine is licensed for treatment resistant depression. Other research supports using ketamine in the treatment of this severe form of depression this but it is not considered a first line treatment for mild depression as it seems Elon Musk is describing here. 

“Some people develop dependence on ketamine which has severe consequences and so the use of ketamine should be carefully weighed up by qualified clinicians with the benefits weighted against the costs.

“The number of ketamine clinics in the US seems to be growing rapidly and we need stricter regulations. Ketamine is not available widely here in the UK.”

Prof James Stone, Professor of Psychiatry, Brighton and Sussex Medical School, said:

“Although ketamine represents a paradigm shift in the treatment of depression, given its rapid onset of action and effectiveness in patients who have not responded to other treatments, it is not a replacement for existing drug treatments for depression. Selective serotonin reuptake inhibitors (such as fluoxetine, citalopram and sertraline) are effective in most patients with depression, can be safely taken over a long period of time, and often lead to complete remission of symptoms. Ketamine similarly requires repeated dosing to maintain an antidepressant response, but has more potential for harm, with risks of addiction being a particular concern. Furthermore, ketamine has not yet been approved in the UK for the treatment of depression by NICE and is currently available in private clinics and specialist services only.”

Declared interests

Dr Rupert McShane: Rupert McShane is a Consultant Psychiatrist at Oxford Health NHS Trust and Associate Professor at Department of Psychiatry, University of Oxford.  He runs a ketamine clinic for patients with resistant depression.  He leads Ketamine2024, an international academic conference focussed entirely on ketamine and related compounds for psychiatric disorders, which is running in Oxford from 25-27^th March.

Dr Paul Keedwell: No declarations

Prof Celia Morgan: My NIHR grant receives additional arms length funding from Awakn Life Sciences and I have consulted for them in the past but I do no longer (ended Oct 2023).

Prof James Stone: I have been involved in the setup of two NHS-based clinics for the use of ketamine in patients with hard-to-treat depression. I was co-investigator on trials of intranasal esketamine sponsored by Janssen.