I could not believe it when the patient asked me about ketamine. I had just seen an episode of “House, MD” on one of those cable super-stations the night before and it dealt with this weird drug. I told my husband about my experiences with it during my surgical career. Then, the next day, this patient brought up the same rare drug. When I looked at him closer, it became believable. He was old enough — in his sixties — that in the swinging sixties he had surely been one of those “knowledgeable” druggies who pride themselves on knowing all about everything that could give one a buzz.
This type of person is a sort of lay-pharmacologist — someone who knows not only how each drug made someone feel, but sometimes even about class of drug and mechanism of action. Of course, this type of expert would seldom know terribly much about what the FDA thought or felt about these drugs. “I heard it works pretty well and faster than anything on depression,” he said, “and I am kind of depressed and the standard antidepressants, the crap like Prozac and Zoloft aren’t worth taking and don’t do anything. But they say that stuff works fast on depression.”
Yes, he knew his stuff so well that he may even have read some kind of FDA reports or something. Still, ketamine is not the kind of thing you can dish out in a county clinic in Noplace, California. If you want something exotic, try a university psychiatry or pharmacology department, or call or email the National Institutes of Health. I could offer the standard stuff, but not ketamine. Not me, not there.