Local psychiatrist’s West Coast Ketamine Center treats patients suffering from depression

Dr. Philip Botkiss

A local psychiatrist has opened a clinic where patients suffering from depression that has not responded to standard medications are treated with ketamine, an anesthetic and pain reliever that is also used by some as an illicit hallucinogenic drug.

Dr. Philip Botkiss, a psychiatrist who lives in Rancho Santa Fe, opened the doors of the West Coast Ketamine Center in November. The clinic is located at 12625 High Bluff Drive, Suite 312, in Carmel Valley.

Patients have the option of receiving ketamine intravenously, or in the form of a nasal spray called Spravato, the latter of which was recently approved by the U.S. Food and Drug Administration for treatment-resistant depression, said Botkiss.

Ketamine has been approved by the FDA as an anesthetic since the 1960s, said Botkiss, but over the past 20 years, a number of small studies have shown its effectiveness for treating depression when other drugs have failed. Doctors often prescribe medications for other than their indicated use when they may provide benefits to patients, he said.

About 30 percent of patients with depression don't respond to standard anti-depressant medications, said Botkiss. In those treatment-resistant patients, ketamine has been shown to not only alleviate their depression, but to act much more quickly than traditional anti-depressants, which can take weeks to reach their full effect. Ketamine also has been seen to reduce suicidal thoughts in people with depression, he said.

"There's no other treatment in psychiatry I've seen in 20-plus years (of practice) that can have such a dramatic and immediate effect on a patient," said Botkiss. "No other treatment has come close to being able to duplicate what I've seen with ketamine."

A study published in 2017 by researchers with the Skaggs School of Pharmacy and Pharmaceutical Sciences at UCSD found that ketamine did seem to help those suffering with depression. According to a press release, the study focused on 41,000 people who had been given ketamine for pain relief, and found that the incidence of depression in those patients who took ketamine was 50 percent less than people who took other medications for pain.

The researchers used a database that includes adverse side effects from a variety of medications, said Ruben Abagyan, a professor of pharmacy at UCSD. Through their analysis, said Abagyan, the researchers noticed a strong correlation between those who used ketamine for pain, and a reduction in symptoms of depression and suicidal thoughts.

"The anti-depressant effects were noticeable, they were statistically significant," Abagyan said. Based on those findings, Abagyan said, the researchers determined it makes sense for clinical trials to be conducted, specifically regarding the use of ketamine for treatment-resistant depression.

However, Botkiss said that ketamine is a generic drug, and due to the large expense for clinical trials, there is little financial incentive for pharmaceutical companies to conduct clinical trials for the intravenous use of ketamine to treat depression. Botkiss said his clinic will offer both the intravenous treatments of ketamine, administered by his partner, an anesthesiologist, and the new FDA-approved nasal spray, which contains a different form of ketamine.

Botkiss said the nasal spray may not be as effective as the intravenous treatment.However, because the intravenous treatment is not FDA-approved, it is not typically covered by insurance, said Botkiss. For the recommended course of six treatments, the cost of intravenous ketamine is about $3,000, said Botkiss. For those who can't afford to pay out of pocket, the spray may be a better option, if it is covered by insurance, he said.

Botkiss estimated that about 80 percent of the patients in his practice have seen some benefit from the intravenous ketamine treatments. He said the side effects are fairly minimal, with some patients feeling sleepy during the treatment, and others having a floating feeling, or a disconnect between their body and mind. The dose used to treat depression is smaller than the amount used for anesthetic purposes, he said.

Botkiss, who also sees patients at Sharp Mesa Vista Hospital, is opening a second clinic in June, at the same location as the ketamine clinic. The new clinic, called the Botkiss Center for Recovery, will offer substance abuse treatment on an outpatient basis, with services available in the evening for those who work during the day.

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