Job diary: I'm an LA doctor who runs a ketamine-infusion therapy program to help people overcome depression, anxiety, and trauma
- David Mahjoubi, MD, 42, is an anesthesiologist based in Los Angeles, California.
- He founded the Ketamine Healing Clinic of Los Angeles in 2014, and says that despite the drug's reputation as an illegal party drug, its use in controlled medical settings can help patients battling depression, anxiety, and trauma.
- Before accepting a new patient, Dr. Mahjoubi says they need to have first tried other anti-anxiety or depression medication in the past. He also recommends that patients pair the ketamine treatment with regular therapy appointments.
- Dr. Mahjoubi says he's never seen a patient experience withdrawal symptoms, but adds he has had to stop prescribing ketamine nasal spray when patients overuse it.
- He says he hopes his clinic can help dispel the negative myths around ketamine, and set a precedent for the therapeutic benefits of psychedelics.
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While I was in anesthesia residency at the University of Southern California Hospital's Department of Anesthesiology from 2006 to 2009, I learned how to put people under for surgery using an anesthetic called ketamine. Afterwards, as I began work as an anesthesiologist at a hospital, I began hearing interesting things about the anesthetic.
Researchers had begun testing it as a treatment for mental health conditions like anxiety, depression, and PTSD — and with encouraging results. Having had friends and family members who suffered from depression, and knowing rates of depression and anxiety in the US were rising, I saw an opportunity to use my training in anesthesiology in a new, impactful way.
Ketamine is a dissociative drug, which means it helps you detach from your body and surroundings, often providing a wider perspective on the problems you're dealing with.
It also has psychedelic properties, so people can gain insight into their lives and even have mystical experiences on it. One study found that it reduced symptoms of depression and anxiety in patients with severe depression, both immediately after it was administered and as well as a month down the line. Another found that it even provided relief from chronic pain that lasted for up to two weeks after treatment.
In 2014, inspired by findings like these and conversations with psychiatrists who were beginning to incorporate ketamine into their practices, I founded the Ketamine Healing Clinic of Los Angeles. Since ketamine has been available for medical use in California for over 50 years, I didn't face any legal issues beyond typical medical requirements.
Our ketamine supplier is Henry Schein, a medical supply company that serves as a middleman between doctors and manufacturers. I knew very little about marketing when I started my clinic, so to start getting customers, I hired an SEO company to make sure we showed up in Google searches and to run ads on social media. Soon, people were referring us to their family and friends.
Nowadays, we see about six or seven patients a day, and I devote most of my time to the clinic, while also spending several hours a week working as an anesthesiologist at LA's Mission Community Hospital and various surgical centers. We've particularly seen a rise in demand for our clinic services since COVID-19, likely due to the struggles people are having with quarantine.
Anyone can call us if they're interested in our treatment — they don't need a referral — but they need to have first tried other anti-anxiety or depression medication or seen a therapist or psychologist in the past.
I'll first schedule an phone consultation with potential patients to discuss what problems they're dealing with and what treatments haven't worked for them, and explain what we do.
During their first appointment, we take their vitals and talk to them about their physical and mental health history, and I determine the right dose and course of treatment for them, which typically involves five or six IV infusions over two weeks followed by maintenance doses once a month to once a year.
I have some patients who have been coming for as long as six years. There's no limit to how long someone can keep coming, unless they develop a medical condition affecting their metabolism of ketamine. I don't allow people with a compromised liver or kidneys to take our infusions, since this can be dangerous.
I make the infusions, which contain anywhere between 25 and 240 mg of ketamine, sometimes a negligible amount of relaxant, and anti-nausea medication if the patient needs it. Then my nurse will set the patient up in a private room, where they sit in a reclining chair and receive noise-canceling headphones so they can focus on their internal experience.
Once they're hooked up to the IV, they'll stay in the room for about an hour, with me or a nurse continually checking up on them. Afterward, we have a discussion about what came up during the infusion, and how they feel the treatment is working for them.
We also sometimes prescribe patients over-the-counter ketamine, which they can take at home as a nasal spray in smaller doses. I've had a few people start craving the spray and taking more than prescribed, in which case I stop prescribing it. I've never seen anyone experience withdrawal symptoms. I also recommend therapy to my patients with PTSD, although many people who come to us have already tried therapy and everything else under the sun.
I learn fascinating things by talking to people who have just finished their ketamine infusion.
Often, the same themes repeat themselves in the kinds of epiphanies people have. The most common things people say are that love is all that matters, that they're done worrying about things that aren't a big deal, and that they want to reach out to and better appreciate their family and friends. We also get some atypical responses. One time, I had to stop a guy who began doing push-ups in the office post-infusion, because he was feeling extra motivated and energized.
Over time, I've seen people undergo big changes in their lives because of their work with ketamine, including a few who left abusive relationships, grew their businesses, or pursued totally new ventures. Overall, the majority of our patients report benefits from the treatment, and people typically come out of their infusions with a newfound will to live and increased clarity about their future. Some patients who came in with suicidal thoughts no longer have them at all.
There are a lot of myths out there about ketamine.
One I often hear is that if you take it, you could fall into a "K-hole," where you lose all sense of your body and reality. While this is possible at very high doses, we are careful to control the dosage, like in any medical procedure, to ensure this doesn't happen to our patients.
I hope that in the future, ketamine therapy will become a more widely used treatment for people struggling with mental health and an option that insurance companies will cover. I'd also like to see a governmental regulatory board offering a certification to ensure that the ketamine clinics out there are truly helping patients. When it comes to my own clinic, I'd eventually like to expand to New York City and possibly Madrid. There are very few ketamine clinics in Europe, probably due to stricter regulations.
Psychedelic therapy is a fascinating and rapidly growing field, and because of ketamine's preexisting status as a legal anesthetic, we've been able to be at the forefront of it. I hope that clinics like mine can set a precedent for the therapeutic use of psychedelics in a safe, caring, and accessible space.
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