Jacintha was at her wits’ end. Her daughter was struggling, and they had tried everything ‒ two types of antidepressants, years of talk therapy and weeks of an intensive outpatient program.
She was frantically Googling one night when she came across an article about ketamine therapy. Jacintha, a horseback rider, was familiar with ketamine as a horse tranquilizer but had never heard of it as a last-stop mental health treatment for treatment-resistant patients like Lucy, who was diagnosed with depression, obsessive-compulsive disorder and post-traumatic stress disorder.
There was only one thing: Most ketamine users are in their 30s or older. Lucy was just 16.
“When people are desperate, you’re ready to take desperate measures,” says Jacintha, who asked that we withhold her last name to protect her daughter’s medical privacy. “I think any parent who sees their child struggling as hard as Lucy was struggling would want to do that.”
Ketamine therapy has been gaining popularity in recent years and, in select cases, has been used to treat young people. Doctors say it can provide life-saving support in instances where other medications have failed, but there are risks involved, including the potential for dependence when improperly administered. Despite the potential dangers, some young users and their families say trying the controversial therapy is preferable to being stuck in the status quo.Dozens of commenters on Reddit talk about seeking out care for minors, but most USA TODAY spoke with declined to go on the record for fear of stigma.
“The detrimental effect on the brain of growing up with severe treatment-resistant depression is far worse than the whatever risk that we associate with the very sporadic dosing of these low doses of ketamine,” says Chair of Psychiatry at Yale School of Medicine John Krystal. However, he adds there’s little research about ketamine therapy’s effect on young adults, and as such, it should be a last resort.
How ketamine therapy works in the brain
A few months after that Google search, Jacintha and Lucy walked into the Northwest Ketamine Clinic’s Bellevue, Washington, outpost, where Lucy began the first of 12 ketamine infusion sessions, all administered in April and May of 2023.
The doctors had explained how the ketamine infusion would work: The chemical would bind to receptors in the brain, interfering with the connection between the brain and the body, leading to a disconnected, out-of-body feeling where Lucy might experience detachment from reality.
That first session, Jacintha held Lucy’s hand, cautiously optimistic. Things got worse before they got better, and Lucy experienced mood swings and random spurts of anger. But after the seventh session, it was like something “just completely shifted.”
The therapy helped her manage her self-harm and contamination-triggered OCD. Before ketamine therapy, hearing someone cough or breathe loudly in the classroom would send her into panic mode, ultimately causing her to drop out of school. At home, she didn’t enter the downstairs kitchen at all, feeling too overwhelmed by the fridge, dirty dishes, and smells from cooking.
After the infusions, “I was feeling way better than ever before,” Lucy says. “It really did shift my mood a lot. I was just generally at a higher level of functioning every day; I wasn’t depressed all the time.”
A representative for Northwest Ketamine Clinic says their clinics don’t treat anyone under the age of 14, but they’ve seen a rise in interest from parents looking to treat teenagers.
Ketamine works by stimulating the brain’s resilience mechanisms, according to Krystal. The chemical targets a different system in the brain than standard antidepressants, triggering the release of glutamate, which stimulates the growth of new synapses between brain cells.
“The plasticity of the brain ‒ the ability to learn, adapt, respond ‒ becomes compromised by depression,” Krystal says. “Even a single dose of ketamine can have a positive effect on this kind of plasticity, which may make psychotherapies and (other) kinds of interventions work.”
Laura Pickard, 23, turned to ketamine therapy in search of relief. She had battled depression and anxiety since age 15, cycling through medications like Prozac and Wellbutrin. In 2022, her father died of an overdose, and just 16 months later, her mother died by suicide.
Following her mother’s death, she paused her education at Baylor University and returned home to Los Angeles, where she began working with a counselor who specialized in loss. She described coming out of her depression as putting on glasses for the first time.
“Before ketamine, everything took five times the amount of effort for me to do because of my depression,” Pickard says. “Going through my ketamine treatments, I woke up motivated to do things; I had energy.”
Pickard has since done three maintenance sessions, which she credited with helping her return to school to finish her degree last year.
‘I still get the sense that I was a little too young for it’
When Krystal started studying ketamine in the 1990s, it was still known as a horse tranquilizer or by the street name Special K. In recent years, high-profile figures like Elon Musk, Chrissy Teigen and Sharon Osborne have talked about using the substance for therapeutic purposes, contributing to its name recognition. Most notably, abuse of the drug was linked to Matthew Perry’s death after he was using ketamine under the care of a physician for the treatment of depression.
Ketamine therapy’s most common short-term side effects are dizziness and nausea, but in extreme cases, long-term, heavy use of ketamine is associated with memory problems, gastrointestinal issues, and urinary tract infections, according to the National Institute on Drug Abuse.
A 2017 case study from the Yale Child Study Center found depressive symptoms dramatically reduced for adolescents ages 13 to 17 with treatment-resistant depression within 24 hours of receiving an infusion of the therapy, and the improvements lasted at least two weeks.
“I really would just proceed with caution on this for kids because it’s not really been studied in that age group,” says Dr. Ryan Sultan, a psychiatrist specializing in ketamine treatment at Integrative Psychiatry. “The younger the brain, the more unformed it is, and therefore the greater potential of negative effects.”
Lucy doesn’t regret the ketamine therapy, but says it’s a bigger step than she realized at the time.
“I still get the sense that I was a little too young for it, and I wonder, could I have tried something else?” Lucy says.
Krystal says that ketamine is most effective in a very narrow dose range: a doubled dose would lead to more side effects, but not more effectiveness, and halving the dose would lose the antidepressant effectiveness. He’s seen instances of misuse where people start using ketamine as many as eight times a day, leading their depression to worsen.
Lucy and Pickard receive treatment through intravenous (IV) ketamine therapy ‒ a legal but off-label use of the drug. The only FDA-approved form of the therapy is an esketamine nasal spray known as Spravato, but the majority of ketamine therapy administered is through IV, according to Sultan. Neither form is FDA-approved for children.
The result is that the field of ketamine therapy goes unregulated. After the FDA approved esketamine in 2019, hundreds of independent, outpatient ketamine clinics sprang up around the country. These clinics might employ a mixture of anesthesiologists, psychiatrists, nurse practitioners and therapists, but quality and safety vary across clinics.
Insurance rarely covers IV ketamine therapy, and users pay hundreds per session out of pocket.
Krystal warns that people using ketamine for therapy outside of clinics often improperly administer it. Most of the ketamine distributed in the United States is done so illegally, according to the Drug Enforcement Administration.
”Adolescents are at greater risk for addiction problems, and so the concerns that I raise about people having access to ketamine at home are even heightened for adolescents,” Krystal says.
Jacintha initially worried about introducing the feeling of ketamine to Lucy, but has spoken with Lucy about the dangers of seeking out that feeling in a non-clinical setting.
“Am I inadvertently introducing her to a euphoric feeling that she may want to continue pursuing in other ways?” Jacintha says. “If she no longer has access to ketamine, but she still wants to go back to the feeling that ketamine gave her, will that lead her into other types of drug abuse?”
Why ketamine therapy isn’t a cure-all
Since April of 2023, Lucy has done four maintenance sessions, one every six months, which she utilizes in combination with talk therapy and antidepressants.
“It’s still prevalent today, sometimes depending on my stress and my mood. But I think the biggest reason why my OCD got more manageable is because my depression was more manageable,” Lucy says.
Still, Jacintha says she wishes they saw bigger results and cautioned that it’s not a miracle cure.
“I wish that this had been the cannonball that we were looking for, to blow this whole thing open, and it wasn’t,” Jacintha says.
Ultimately, Lucy and Jacintha knew the risks of ketamine therapy. But they agreed any side effects would pale in comparison to the struggles Lucy was experiencing.
“If people think that I’m a bad parent because I chose to give my child ketamine, I would invite you to come and live my life,” Jacintha says. “When you have a child that is in such acute mental anguish, and you see them drowning every day, you cling to hope, that’s all you have.”
Rachel Hale’s role covering Youth Mental Health at USA TODAY is supported by a partnership with Pivotal and Journalism Funding Partners. Funders do not provide editorial input.
Reach her at rhale@usatoday.com and @rachelleighhale on X.