It looks like just another nondescript office building in downtown Santa Monica. But enter the second floor, and you’ll find a setting fit for a tech company meditation retreat.
There are a living moss wall, couches lined with pink velvet pillows, carefully placed fiddle leaf fig trees, and a soundtrack of chill lo-fi beats. The setting is perfectly calculated to hint at the Age of Aquarius – in a safe way. More West Elm than Woodstock.
Welcome to Field Trip Health: LA’s high-end destination for what the company calls “ketamine-assisted psychotherapy.” It’s just one of at least a dozen clinics across the city offering the hallucinogen previously known as Special K as a treatment for depression, anxiety and a host of other ailments.
Prospective clients have their choice of style and delivery method. There are the retail clinics, where an anesthesiologist administers the drug through an IV or shot. There are also companies like Field Trip, where a more spiritual experience is encouraged. And there’s at least one botox clinic in West Hollywood that has ketamine on the menu in the same category as vitamin IV drips and cryotherapy.
Ketamine has been used as a general anesthetic since the 1970s and a party drug since the 80s. But it wasn’t until the early 2000s that researchers discovered its anti-depressant effects. In 2019, the drug was FDA-approved in the form of a nasal spray called esketamine or Spravato, which is recommended for patients suffering from treatment-resistant depression or major depressive disorder with suicidal thoughts. The FDA has strict and specific guidelines for using Spravato; when patients start a course of the treatments, doctors also have to start them on a standard antidepressant, inform them of any risks and monitor them closely for side effects.
How is it legal for specialty clinics and botox centers to give ketamine to just about anyone who can afford it? Because of that FDA approval, any doctor can prescribe the drug for off-label use. Even better for psychedelic entrepreneurs, the patent for ketamine expired 40 years ago, which means it’s cheap for clinics to buy. But not so cheap for patients: A single session will set you back at least $500 dollars.
Fast forward to 2022, and this 80s club drug has fully entered the wellness space.
Mike Dow, a therapist at Field Trip Health in Santa Monica, is young, good looking and sharply dressed. He’s no stranger to the wellness industry or the media. He’s written seven books about health topics like brain fog and sugar cravings and he’s often appeared as a therapist on shows like “Dr. Oz” and “Live With Kelly.” He also happens to be a ketamine evangelist.
“Ketamine is very bio, psycho, social, spiritual,” Dow says. “It really hits all four quadrants of somebody.”
He recommends ketamine for people who’ve found western medicine to be too focused on treating the biological causes of depression, like genetically low levels of serotonin. Ketamine, he says, is a more holistic approach — perfect for a certain LA crowd.
“I think if you have a place like LA where people tend to be very open-minded, very health-oriented, they go to Earthbar or Kreation, have their green juice and don't go to fast-food restaurants,” Dow says “I think those people also probably want to consider psychedelic-assisted psychotherapy.”
Dow says what really sets Field Trip Health apart from other ketamine clinics is its interior design. “I think the first thing that people say is that it feels almost like a resort in Tulum, not a doctor's office,” he says. “And that is very intentional.”
He points to the color palette of the space (earthy tones, lots of pinks), the geometric theme (inspired by the symbols and shapes repeated in nature) and the general aesthetic (Millennial Zen). It’s a modern twist on a long-held psychedelic tradition where set and setting are of utmost importance. As any shaman will tell you, a relaxing atmosphere can mean the difference between a good trip and a bad one.
At Field Trip, therapists sit in the room with the patient during the whole two-hour session and do a series of “integration sessions” with them afterwards, to fully process the experience. They recommend most people start with four to six ketamine sessions over several weeks. A full course of treatment at Field Trip adds up to between $3,750 and $5,750 with optional “maintenance doses” every six months (or whenever unpleasant symptoms return).
Inside Field Trip’s treatment rooms, patients will find a zero-gravity chair, a phone pre-loaded with trip-appropriate playlists, noise-canceling headphones and an eye mask. A nurse comes in to administer the medicine via an intramuscular shot, and within just a few minutes, “you're going to what we call ‘Leave the room,’” Dow says.
Ketamine has a hallucinogenic effect similar to mushrooms or LSD and usually causes a feeling of intense dissociation from your physical body. Some describe it as a total loss of ego or any attachment to who or where you are.
That’s exactly how it felt for Bri Emery, a creative director in her 30s who recently left LA for upstate New York, and has long struggled with PTSD from childhood abuse.
“It was crazy,” she says of the experience. “I was a part of everything. LIke I was the tree at one point. I was the leaf.”
Emery says that during each trip, she left her body and traveled to a sort of dream world.
“It felt like I was on like a drone, riding over these just gorgeous nature scenes, these beautiful colors and realms and altars with roses,” Emery describes. “It was a little bit like It's A Small World and Space Mountain mixed together. But very slow. Very beautiful.”
Emery says the treatments she got at Field Trip helped ease her PTSD symptoms.
“I'm still experiencing clarity months later,” she says.
You’re probably wondering if all of this is too good to be true.
The answer is it might be.
The FDA trials for esketamine, the nasal spray, have shown that the drug can be highly effective for treating depression with no major side effects. Those studies, similar to some of the largest studies of generic ketamine, found that about 50% of people with treatment-resistant depression felt significantly less depressed within 24 hours of the treatment and about 30% went into remission, meaning they no longer qualified as depressed, at least in the short term.
One recent study conducted by researchers with private software developer Osmind and Stanford University surveyed about 9,000 depression patients who received treatments at ketamine clinics across the country and came up with the same response rates, noting that ketamine reduced suicidal thoughts for the majority of patients. Alison McInnes, who co-authored the study, says a 50% response rate is significant.
“You don’t get anywhere like that in psychiatry,” she says.
Gerard Sanacora, a neuroscientist who runs the Depression Research Program at Yale, also offers his dose of cautious optimism, saying he has personally seen ketamine therapy save people’s lives.
“It's a treatment that has some real concerns attached to it, and it has to be developed responsibly.”
Sanacora, who has been studying ketamine for over 20 years, says the biggest problem is that studies are ongoing, and there’s a lot we still don’t know about how ketamine works.
“There is very limited high-quality data of ketamine’s efficacy and safety or esketamine’s efficacy and safety in anything beyond treatment-resistant depression.”
Treatment-resistant depression refers to patients who have already tried at least two regular antidepressants that didn’t work for them. That’s a very specific subset of people.
The problem is that most ketamine clinics aren’t just giving the drug to people with treatment-resistant depression. They’re marketing it to people with a whole range of mental and even physical health issues.
“I personally think it's the jack of all trades,” Dow from Field Trip Health says . “I've seen it work with depression. I've seen it work with anxiety, PTSD, and then all these other sort of out-of-the-box concerns [like] endometriosis, chronic Lyme disease, if you’re feeling really stuck, you are going through a divorce, [or] you're just feeling like you just can't get started in your life.”
But Sanacora says there’s not enough evidence to back up Dow’s claims.
“It would be nice if they had some data actually showing that. We just don't have enough information.”
McInnes also echoes that point in her study. She says that ketamine clinics have opened across the U.S. “despite a lack of conclusive long-term data” on how ketamine works for people with conditions other than depression, how long the effects of the treatment last and how often maintenance doses are needed.
NOT ALL TRIPS ARE GOOD TRIPS
In 2020, Julia Wilde, a writer living in North Hollywood, signed up for six sessions at Ketamine Clinics Los Angeles, one of the largest clinics in LA, located in an office building near LAX. Wilde says she has struggled with depression since high school.
The first session, Wilde says, was fine. But her second trip took a dark turn.
“I felt like I was in hell,” Wilde explains. “It was just this existence, this loop that I would be stuck in forever.”
Unlike Field Trip Health, Ketamine Clinics Los Angeles doesn’t have therapists in the room with patients. Nurses observe treatment rooms on monitors, and there’s a button patients can push for emergencies. Wilde says that wasn’t enough.
“I hit the button several times. I waved my hands. And nobody came in for several minutes.”
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Sam Mandel of Ketamine Clinics Los Angeles says the clinic “monitors patients’ vitals and keeps eyes and ears on them at all times,” adding his team “is known for being especially attentive to patients’ needs.”
Wilde says although a nurse did come to turn down her dosage eventually, things took a turn for the worse.
“Within a couple hours, I felt the worst depression and intense suicidal urges I ever had, and I was like, ‘What is this? This isn’t me.’ I was not prepared for that side effect.”
Wilde says the clinic had not warned her about the possibility of a reaction like what she experienced.
“Nobody told me [I] could feel that low afterwards.”
Dr. Sanacora says Wilde’s experience is rare, but not unheard of.
“A small percentage of people clearly feel worse after the treatments,” he says. “Another percentage of people feel really bad during the treatments. I mean really bad. When I say a small percent, I mean like 5%. That is not that small when you're looking at large numbers of people.”
McInnes’ study of real world clinics found that 8% of patients experienced worsening symptoms during their ketamine sessions. She says doctors should tell prospective patients about the chances of having a bad trip before they agree to it.
“It should be standard consent that there is a possibility that you could worsen.”
Dr. Sanacora says he is most concerned about the one-stop-shop mentality of depression treatment that ketamine clinics encourage. Most of these clinics work with patients for a few weeks or a month or as long as it takes them to finish the recommended number of treatments. Most people just show up for their appointment, get the ketamine dose and leave, only getting in touch months later if they want another session.
But what patients really need, Sanacora says, especially those dealing with serious mental health issues, is a doctor or therapist who is working with them and monitoring their condition long term.
“It’s actually not good clinical practice to start Prozac and not follow somebody closely, no less start something like ketamine and not have a good follow-up management plan,” he says. “It would be like coming in to have your appendix taken out, and then you're just sent out, and nobody's going to follow you up or do anything else.”
Despite the common psychiatric belief in treating a complex mental health condition from multiple angles, the therapists at Field Trip Health might lead people to believe that after ketamine, they’ll no longer need daily antidepressant medication.
“Some people notice their improvement is so much [that] they then work with their prescriber, and they can go off their medication,” Dow says, adding that those who choose to stay on their medication will notice that it’s “going to work better” after the ketamine sessions.
Dr. Sanacora says it’s really an issue of managing expectations. You want to make sure people don’t lose hope, he says, but you also don’t want people to think this is the last resort, and that if it doesn’t work, there’s nothing more to be done. He says there’s a real danger in having someone go into a ketamine clinic with the expectation that if they pay $5,000, they’re going to get better. If that doesn’t work, “they’re in an even worse position,” he says.
Sanacora adds that doctors and therapists at these clinics should be honest with prospective clients that the treatment works for about half of the people who try it. But that’s not what Field Trip Health claims. Its website notes 96% of clients exhibited progress with anxiety after treatments while 95% experienced their depression symptoms improve.
The truth about ketamine is this: It really isn’t meant to be a one-stop cure for depression, no matter how much we might want it to be. But by marketing it that way as a life-changing miracle cure, a lot of ketamine clinics are overselling the benefits of the drug without being fully transparent about everything we still don’t know.
Depression is a painful and debilitating illness. There's a serious need for new treatments, and there’s a lot of hope that ketamine could be the answer. And hope is a powerful thing.
Just look at Julia Wilde. Despite having a trip that felt like being “trapped in hell,” she says she’s considering trying it again.