Saving Lives and Stopping Suicide: Interview with Zappy Zapolin

can i buy clomid over the internet Mike “Zappy” Zapolin is an accomplished entrepreneur and filmmaker behind the psychedelic advocacy film The Reality of Truth which follows actress Michelle Rodriguez and her experiences in South America with ayahuasca and San Pedro. It’s been three years since we first spoke with Zappy, and since then he has started a nonprofit called The Ketamine Fund, which grants free ketamine treatments to veterans and others who are suicidal. Today we speak with Zappy about this new project, and why he has shifted his sights from plant medicines in foreign countries to ketamine treatment here in the United States. 

apprenez ceci ici maintenant Thanks so much for speaking with us again, Zappy. It’s been a few years since your documentary site rencontre echangiste gratuit The Reality of Truth came out. What have you been up to since then?

First off, we’re really excited that over 6 million people have watched the movie since it came out. I’ve gotten some great feedback—incredible things like people saying, “I was going to commit suicide then I saw this movie and I started doing plant medicine and it totally changed my life” and “I was a drug addict and homeless and I found plant medicine through this movie.” It’s so heartwarming to hear that kind of stuff. We’re dreaming of a day when a million people will have done plant medicine as a result of The Reality of Truth, and I feel like it’s heading in that direction.

When I came back from filming The Reality of Truth, I was telling everybody about going down to the Peruvian jungle and sitting with a shaman, and it struck me that the people who seemed to really need it the most were like, “Woah Zappy, I can’t do that. If I tried to tell my family I’m going to go sit in the jungle with a shaman they would put me in a mental institution.” It was frustrating, and I felt like I needed to find a Western medicine approach that could offer some of the same benefits. So I kept exploring and having more experiences, and I wound up finding ketamine. 

A doctor had told me about four or five years ago what ketamine was all about, and I decided I wanted to try it. I went through a series of treatments like they would do for somebody who was depressed or had anxiety. As soon as I did it, I was like “Wow, this is like a one hour, tight, clinical ayahuasca ceremony, where you go into present moment awareness. You are sitting there with no future, no past, and you can live a thousand lifetimes in this one 45 minute session.” What’s really cool about it is that it wears off really quickly, so you can go back to work later if you need to. The integration is much different than with ayahuasca, where you really want to spend some time reintegrating. 

Ketamine is FDA approved—it’s been proven to be extremely safe, and they even use it as an anesthetic on children. It’s everything that Western culture needs in order to go deeply inside the mind, have a conscious transformation, and then come back out and carry that forward in day-to-day life. I realized then that ketamine could be the gateway to plant medicine, because it’s been my experience that most people who come out of ketamine treatment are wide open to meditation, breathing, plant medicine, microdosing… they’ve just had this complete transformation in one 45 minute session.

I’m really excited because I think ketamine is our approach right now. When you look at the current landscape, you can see that psilocybin and MDMA are going to come out at some point in the next few years, but ketamine is now. It’s FDA-approved; there are probably about 100+ clinics right now in this country that are using ketamine for depression and anxiety, so this is a legitimate opportunity for a deep and transformative inner experience.

Ketamine has immense potential to reverse the suicide epidemic, the depression epidemic, and to help save our veterans. This is what really got me into starting The Ketamine Fund, which is our 501(c)(3) nonprofit. The #1 side effect of ketamine is that it breaks suicidal ideation immediately. What happens is that people go into that present moment awareness, and all of a sudden they see all these different option sets that are available to them, whereas before it might have seemed like trudging through life or commiting suicide were the only two options. When they see these new possibilities, people will say “I can do this, and I can do that; I forgot that I enjoy doing this”, and so on. It breaks that negative cycle and opens people up to new ways of living and a sense of hope and optimism again. 

At the Ketamine Fund, our goal is to bring down suicide rates by 75% across the country. Basically, if anyone says they’re having suicidal ideation, they get a free ketamine treatment at a clinic near them. We’ve already aligned with 30 or so clinics around the country who are taking our needs-based people, and we’ve decided that we would start with veterans specifically because they’ve had so much trauma and really deserve this help. 

My partner Warren Gumpel and I started the program in Salt Lake City, Utah and have donated 400 ketamine treatments so far. The results are incredible. You can go to and see some of the videos of these veterans. They came in suicidal, they were the worst case scenario, then they have the ketamine and it just cleans their slate. One guy was on 22 medications from the VA, and now he’s on no medications—he’s just doing his regular monthly boosters with the ketamine. He said after the first treatment, he went home and hugged his kids and felt the love for the first time in 10 years. How else could you do that, other than maybe somebody going to Peru, sitting with a shaman, and all this deep integration afterwards? This guy went into his Western medicine doctor’s office near his house, got the treatment, came home and his life was changed. To see these transitions happen so fast is incredible, because you don’t have to wait around weeks or months or years to see it—in fact, it’s instantaneous. That’s been amazing. 

That’s really awesome. Here at Psychedelic Times we’ve covered a lot of veteran-focused initiatives using psychedelics like ayahuasca, ibogaine, 5-MeO-DMT, and MDMA to treat and overcome PTSDlike VETS, Veterans of War, Veterans for Natural Rights, documentaries, MDMA research, and so on. How would you contextualize ketamine within this array of treatments for PTSD and suicidal ideation? If I’m a veteran and I’m not sure which treatment is right for me, what should I know about the ketamine option?

I consider ketamine to be like the ultimate triage. Plant medicines are wonderful and someone might still need to do ibogaine, or get a hug from the grandmother doing ayahuasca at some point. All of these have their places, but ketamine is FDA-approved, legal, and available right now, making it far easier to access without doing anything illegal or taking a trip overseas.

Secondly, the preparation, aftercare and integration with plant medicines is a very significant thing. You want to make sure you’re in the right set and setting, and you want to have the right people to guide you and give context to what you experience. Ketamine is quite different. You go into a doctor’s office, and even if the staff don’t really have an appreciation for what it is, you can sit down in the chair, do your thing, and come out of it a changed person. You don’t need a shaman or therapist to guide you during the experience. So with plant medicines there are a lot of factors beyond the medicine itself that you need to get right, but ketamine seems to be highly effective without needing these extraneous factors to be just right. 

The science is showing us that a region in the brain called the lateral habenula records all the stress you’ve had in your life. When it gets to a certain tipping point, it goes into a ‘burst’ mode and shuts off dopamine production, so you’re not getting dopamine anymore—nothing is making you happy, and you get depressed all the time. After doing ketamine, it seems to reset the burst mode, and all of a sudden you can produce dopamine again. In the hours after the ketamine treatment, it metabolizes into 6-hydroxynorketamine, which is building new neural pathways in your brain around trauma and patterns of depression. So a lot of people walk in after years or even decades of severe depression, and come out with motivation, excitement, and joy for the first time in seemingly forever. 

We have amazing veteran stories, and people who came in suicidal and walked out looking at the flowers. I don’t think there is anything that is as quick, as safe, and that needs as little set and setting and integration to be effective, as ketamine. So I think, let’s embrace it. 


JR Rahn Joins Ketamine Fund Advisory Board

The Ketamine Fund is pleased to announce that JR Rahn has joined as an Adviser.

JR is a leader in advancing psychedelic medicine with a deep background in entrepreneurship and strategy.

For more about JR (linkedin)

Ketamine Fund Pilot Program Underway

More than 400 FREE treatment will be provided to Veterans by the Ketamine Fund as part of our mission to save lives and stop suicide.

Read the press release here

Ketamine Saved My Life

I’d dated and known enough addicts in my time to know about Special K, but my psychiatrist told me to try it for my depression. And I am glad I did.

“Think of it this way,” my psychiatrist said. “It would be unethical for me not to refer you to a treatment that I think may work for you.” The treatment was ketamine infusion, which has increasingly been found to be helpful in treating previously untreatable and drug-resistant depression.

I sat across from her with all the telltale signs of depression and anxiety evident in my body language. My legs were double-crossed (leg over leg, then ankle wrapped around its opposite calf), my hands gripping each other, my body moving slightly back and forth in the chair. I was yawning and my eyes felt heavy. I was about to go on an almost-three-week-long trip; I was exhausted before it had even begun, and here was my psychiatrist telling me that she’d like me to try ketamine treatment for my depression. We’d exhausted all other options. This seemed to be it.


Two months later, I was lying down in the offices of Dr. Glen Brooks in New York. In the interest of full disclosure, the treatment I was about to receive six times over the course of two weeks—the initial infusions after which the treatments are fewer and farther between—is not cheap. It is, in fact, ridiculously expensive, and it is only because I am lucky enough to have had a bunch of people die in my life that I was able to afford it. Maybe it’s my natural inclination and maybe it’s my depression, but I find gallows humor in that fact: all four of my grandparents and my father died before I reached the age of 17. It is because of their deaths that I could afford to treat the depression that may have been caused by their deaths, as well as by various other things.

I had my doubts about ketamine treatment, especially as I’d dated and known enough addicts in my time to be wary of anything that I knew to be used recreationally, and Special K, while maybe not as popular as X or MDMA these days, is still abundant. My psychiatrist told me that ketamine is used, for the most part, in intensive care units and emergency rooms. She described how, when she was on rotation as a resident a long time ago, an eight-year-old boy came into the ER with third-degree burns on his arm. He was howling in pain. The procedures to treat burns are—and this is a gross understatement—unpleasant, and she had no idea how the doctors would be able to keep him in place to clean the wounds and sluff off the excess burned skin. What they did was give him an infusion of ketamine and put Spongebob Squarepants on the television. The boy sat there, utterly calm, watching the cartoon. As a child who’s endured several extremely painful procedures (one of which involved all my toenails being crushed and needing to be picked out of my flesh), this struck me deeply.

It was Dr. Brooks who finally convinced me, though I suppose my being there meant I was going to go through with it. He calmed me down beforehand, told me the stuff wasn’t addictive, and showed me two images of rats’ neurological pathways. Rats who’d been made depressed and given peanut butter for a week had broken and shriveled pathways; similar rats whose peanut butter had ketamine in it showed new growths splitting off from the existing, already more robust pathways. It looked, to say the least, promising; this is what ketamine does in humans with depression too—it treats people whose dopamine and serotonin are actually being generated normally (unlike people for whom SSRIs and other antidepressants work), but for whom the pathways for those chemicals to go through are broken or underdeveloped—often because of early trauma of some sort, whether specific and pinpointed (such as physical or emotional abuse) or complex (made up of many smaller events that don’t seem obviously traumatic). I was surprised to learn that my symptoms of depression and anxiety, along with others, all matched the symptoms of PTSD, but Dr. Brooks said that I had them all except for rage (which I also have, if I’m being perfectly honest, though it wasn’t on display that first day).


When he hooked me up to the IV, I was nervous. I am told that I am a type-A, and while I don’t exactly know what that means—I’m not a Myers-Briggs personality type aficionado, or any other personality type test at that—I’ve gathered that it means that I like being in control, that I pay attention to details, and that I’m a perfectionist to the point of self-destructiveness. While the loss of control is appealing to me on an abstract level, the reality of it is rarely something I enjoy.

I put on my headphones—I was instructed to bring music—and sank into a playlist titled “Peaceful Piano.” The next hour passed in a strange state of timelessness, a floating feeling in which I didn’t think anything much mattered, in which I felt a sereneness that was discomfiting to that part of my mind that is unable to detach from any experience.

The scariest part was towards the end, when a Beethoven piece came on. When I was little, the piece was on a tape I used to listen to when falling asleep, a tape called “Beethoven Lives Upstairs” which told the story of the composer’s life and music through the eyes of a fictional boy who was his neighbor. On that tape, this particular piano piece narrated Beethoven’s death.

“How are you feeling, hon?” Dr. Brooks asked me, holding my hand as he came in when the infusion was just about done, when this melody was still playing in my ears.

“It feels like dying,” I told him. He frowned and told me it wasn’t supposed to feel like that. “No, no,” I tried to explain. “It’s good. It’s nice. It’s going to be okay.” He patted my hand again, and with a pained expression told me I wasn’t dying, and repeated that it shouldn’t feel like it.

I made the connection between that remark of mine and the melody later, when I was coming out of the strange stupor-like high that the ketamine had put me in. I explained this to Dr. Brooks, but he still seemed profoundly sad for me. Every time I tell him how badly I feel, he shows a true empathy that I’ve found rare in the medical profession. He feels for his patients, whether they come to him for depression or for terrible neuropathic pain (another thing that K treats).

After the first three infusions, I called him. I had a bounce in my step. I’d been giggling for days. Enjoying sex more. I hadn’t napped in days. “I kind of feel on top of the world,” I told him.

“Oh. Em. Gee,” he said back, and I could hear the smile in his voice.


What I haven’t said yet was that shortly before my first ketamine treatment, I became suicidal for the first time in my life. I had never before wanted to die in the immediate sense, until then. If I hadn’t started ketamine treatments when I did, I don’t know whether I’d be here writing this article now. I had so many pills lying around on my dresser from past attempts at medication that hadn’t worked, that I knew exactly how I would go. Enough of those, my partner out of the house, my phone in another room, and I would die painfully and with lots of vomiting, but I would still likely die.

I didn’t die. I went and got treatment. Treatment that I am lucky to be able to afford, and that I wouldn’t be able to afford if I didn’t have parental support.


Why then, if this treatment is so incredibly helpful and getting so much press (I am far from the only one with a ketamine success story) is it still relatively unknown and not widely available? Why is it so expensive? Why is it that there are so few studies being done, and that the few studies that are being done are testing new drugs that have K in them rather than developing a cheaper method to give ketamine to patients?

The answer is simple, and it was Dr. Brooks who explained it to me: money. Ketamine is a generic, its patent lapsed, and is thus not making any big bucks for pharmaceutical companies. Developing ketamine into something more readily available—especially when it’s a controlled substance and will require a lot more research to make it FDA-approved for the use in depression—means spending a lot of money, very little of which a pharmaceutical company would see back in its coffers. The studies being done on straight K are mostly university and NIH funded. Big Pharma is much more interested in finding a pill that combines K with something else so they can patent it and make money off of the backs of the mentally ill.

So while it does seem like there’s a future for ketamine treatment, it doesn’t seem like it’ll be getting much cheaper than the privately administered stuff that the few and far-between anesthesiologists, like Dr. Brooks, are able to offer.

Ilana Masad is an Israeli-American writer living in New York. Her work has appeared in The New Yorker, McSweeney’s, Marie Claire, Tin House, Printer’s Row, Joyland Magazine, Broadly, Hobart, and more. Find her at her website or tweeting about books, writing, and feminism. She is also the founder of The Other Stories, a podcast featuring new, emerging, and struggling fiction writers.



How Ketamine Saved Her Life

Becca Belofsky Shuer tells Healthline about her lifelong journey battling depression and despair. Now, ketamine keeps her darkness at bay.

On the inside of her right wrist, Becca Belofsky Shuer wears a tattoo of a semicolon.

It’s a symbol of solidarity with other people at risk for suicide.

She chose it to give her courage to fight her dark thoughts.

Shuer longed for death.

But, four months later, she began a series of infusions of the drug ketamine that have kept the darkness at bay.

Shuer told Healthline she felt the drug “cleaning her brain,” beginning with her second treatment in January 2016.

Ketamine works quickly, according to a meta-analysis published in October in the American Journal of Psychiatry.

That report pooled data from 10 previous studies of IV-delivered ketamine.

Within a day of their first drip, more than half of the participants were free of suicidal thoughts for up to a week.

Shuer, a warm and vivacious woman who loves books and comedy, now leads counseling workshops on clutter and hoarding with her husband, Lee.

She returns for a ketamine infusion whenever she feels her mood darkening.

This year, she has been able to go as long as three months between treatments. Four months ago, she began using ketamine lozenges every day as well.

“Life got really hard, but I didn’t put a period there. I put a semicolon, and I kept going,” she said.

New use for an old drug

Ketamine is a common, inexpensive anesthetic for surgery.

In poor countries, it’s essential.

It’s also a top choice on the battlefield, and is still widely used by veterinarians.

As with any drug, the effect of ketamine varies with the dose and delivery method.

Clubbers at “raves” like Special K’s “out-of-body sensation.” They inject, snort, or smoke it and too often dangerously mix it with other drugs.

Clinics providing ketamine as an off-label (not FDA-approved) antidepressant have popped up around the country, typically headed by an anesthesiologist.

The research on its antidepressant effect is almost entirely based on carefully fine-tuned IV drips.

A handful of doctors spray it into the nose or inject it into a muscle.

The dose is a fraction of what recreational abusers take or what you’d get in a surgery.

In 2016, the Food and Drug Administration (FDA) put a nasal spray delivering a variation called “esketamine” on the fast track for approval as a treatment for suicidal people.

Current popular antidepressants focus on serotonin or noradrenaline pathways in the brain, or both.

Ketamine is more like a “reboot” on your computer.

It temporarily blocks a molecule on the glutamate pathway connected to memory and seems to prompt new brain connections to spring up.

James Murrough, a psychiatrist at Mount Sinai Hospital in New York and a lead author of a favorable report in 2013 who was also involved in the recently published meta-analysis, notesthat research on ketamine first revealed the connection between this pathway and depression.

In low doses, ketamine is a powerful anti-inflammatory as well. Depression is associated with chronic inflammation.

Can you have a bad “trip” on the drug?

David Feifel, a psychiatrist who treats patients with ketamine in California, told a writer for the journal Lancet: “It’s exceedingly rare, usually dose related, and very transitory due to ketamine’s rapid metabolism.”

Treating patients

There is no research on the long-term effect of IV ketamine infusions for depression.

Since it is a generic drug, Brooks points out, pharmaceutical companies don’t have a reason to invest in research in that form of delivery.

But they are looking for alternatives. The goal is to find more convenient forms that don’t provide any “high” but dampen depression.

Meanwhile, patients are looking for help. The age-adjusted suicide rate in the United States increased 24 percent from 1999 to 2014.

In addition, standard treatments fail a third or more of the severely depressed.

“The typical patient I see is, or has been, suicidal, often has been hospitalized, and has done ECT [electroshock therapy] or TMS [transcranial magnetic stimulation], and tried different classes of antidepressants and nothing has helped,” said Glen Brooks, an anesthesiologist who treats Shuer.

He treats severe depression or neuropathic pain with ketamine in offices in New York City and Pittsburgh.

Brooks usually gives new patients six infusions, separated by a day, or six in a row for patients visiting from faraway.

Younger people do better. The rate of success drops from the age of 50 on, Brooks told Healthline.

Like Shuer, patients tend to come back every four to six weeks for boosters over a year and half, he said.

Brooks looks for signs of symptoms in childhood, triggered by stress or trauma at that time.

Shuer, he said, “fits the profile of pretty much all our patients. She had a history of depression beginning at age four. An abusive, neglectful mother. By age 26, she was suicidal. High school was tumultuous and she had GI distress.”

Early tragedy

Shuer’s childhood included a shock on top of a background of sadness.

Her 29-year-old brother ran upstairs to save a litter of kittens during a house fire and died himself.

It was a characteristic act, Shuer told Healthline.

“I worshipped him. He had always been the hero in our family,” she said.

Shuer was 13. The tragedy devastated her and her parents.

“I was on my own after that. They talked about death every day. They had a suicide pact, that if anything happened, they didn’t want to go on,” she said.

Her mother, she guesses, already had a mood disorder.

“I never knew if she was going to be happy vibrant mom or depressed quiet mom,” Shuer recalled. “When she was happy, the world was happy.”

Her mother would sometimes disappear into her bedroom for a couple of days and Sheur’s father would say, “Mom’s not feeling well.”

“I was a very sad child, sad for no reason. I had everything I could need,” Shuer said.

Eight years younger than her nearest sibling, Shuer grew up feeling isolated, watching talk shows and news with her mother.

She had asthma and she heard her pediatrician tell her parents to stop smoking, but they didn’t.

In school, she was the smallest child in every class and often bullied.

By high school, Shuer was drinking three nights a week, smoking cigarettes, and writing poetry about slashing herself. She picked at her face compulsively and her skin became covered with scabs.

One day a teacher looked at her and said, “Becca, what are you doing to yourself?”

“I was always in agony,” Shuer said.

She had a constant pain in her gut. She also had migraines that were first diagnosed as “psychosomatic.” To her, the term just meant “psycho.”

By the age of 26, she was thinking constantly about how to kill herself.

One day she called a suicide hotline and said, “I don’t want to die, but I want to die.”

The person who answered gave her hope.

“She was amazingly helpful, “Shuer remembered. “She said, ‘You’re not alone. This is something that happens. There is help for you.’”

Shuer began taking Prozac, which felt like magic.

“The colors came on in the world,” she said.


Mourning in midlife

Over the next two decades on Prozac, Shuer developed a satisfying career helping autistic children and their families, and a supportive marriage.

But in her 40s, troubles hit rapidly.

Within three years, her father died of smoking complications. Grief stricken, she also had to leave her job in Massachusetts to tend her mother in Florida, who was now on hospice care.

Her beloved cat died. Her migraines got so bad she sometimes stayed in bed for a week.

Shuer tried seven medications with the goal of treating her migraines and depression together.

“They caused such a mixed bag of effects I hated them,” she said

Nothing worked, and Shuer again began thinking seriously about suicide.

Shuer was also coping with a shortage of psychiatrists near her Massachusetts home. Two, in fact, retired while treating her.

Feeling very much on her own, she hit the internet and found Dr. Brooks in New York after speaking with two doctors in Boston.

“He’s a real person, a mensch,” she said.

Can you afford it?

In the United States, doctors charge from $400 to $800 per infusion, reports the Ketamine Advocacy Network, which offers a partial list of providers.

Some, like Brooks, aim to make it affordable for people in need. About a third of his patients, he said, receive some insurance reimbursement.

You must be continuously monitored during your infusion, which runs from 40 minutes to an hour.

Some providers will stay with you and, if you choose, provide support as a kind of talk therapy. Others leave the room but monitor you.

Shuer, who studied psychology at Smith College, likes to be alone during the infusion with her thoughts.

“It’s like the ketamine interrupts the horrific pain associated with the memory so you can have the memory and not feel destroyed by it in the moment,” she said.



Can We Stop Suicides? -The New York Times

It’s been way too long since there was a new class of drugs to treat depression. Ketamine might be the solution.

By Moises Velasquez-Manoff

In May of 2017, Louise decided that her life was just too difficult, so she’d end it. In the previous four years, three siblings and a half-sibling had died, two from disease, one from fire and one from choking. Close friends had moved away. She felt painfully, unbearably alone. It would be the fourth time Louise (I’m using her middle name to protect her privacy), then 68, would attempt suicide, and she was determined to get it right.

She wrote a letter with instructions on where to find important documents and who should inherit what. She packed up her jewelry and artwork, addressing each box to particular friends and family members. Then she checked into a motel — homes where people have committed suicide lose value and she didn’t want hers to sell below market — put a plastic sheet on the bed, lay down and swallowed what she figured was an overdose of prescription pills with champagne.

A few days later, she woke up in a psychiatric ward in Albuquerque. The motel maid had found her. “I was very upset I had failed,” she told me recently. So she tried to cut her wrists with a bracelet she was wearing — unsuccessfully.

The suicide rate has been rising in the United States since the beginning of the century, and is now the 10th leading cause of death, according to the Centers for Disease Control and Prevention. It’s often called a public health crisis. And yet no new classes of drugs have been developed to treat depression (and by extension suicidality) in about 30 years, since the advent of selective serotonin reuptake inhibitors like Prozac.

The trend most likely has social causes — lack of access to mental health care, economic stress, loneliness and despair, the opioid epidemic, and the unique difficulties facing small-town America. These are serious problems that need long-term solutions. But in the meantime, the field of psychiatry desperately needs new treatment options for patients who show up with a stomach full of pills.

Now, scientists think that they may have found one — an old anesthetic called ketamine that, at low doses, can halt suicidal thoughts almost immediately.

Depression ran in Louise’s family. It had afflicted all her siblings, both of her parents and her grandmother. Prozac had helped Louise for a time, but stopped working for her in the late 2000s, as it sometimes does. No other drug seemed able to lift her dark moods.

After her suicide attempt, Louise’s psychiatrist suggested she try ketamine. She agreed, and received an infusion intravenously. Within hours, her sense of well-being improved. The hospital discharged her. Back home, she discovered that going to the market was no longer a “herculean task.” Getting her car washed wasn’t an insurmountable chore. “Life was better,” she said. “Life was doable.”

Using ketamine to treat depression and suicidality is somewhat controversial. Numerous small studies suggest that it holds great promise, but it’s only now being tested in placebo-controlled trials with hundreds of patients. It is also popular as a club drug in some circles. Like morphine, it may operate on the opioid system, and it can induce feelings of euphoria. Occasionally ketamine abusers develop severe symptoms, including brain damage, persistent hallucinations and a painful inflammation of the bladder called cystitis.

Nonetheless, if proven safe and effective in small doses, ketamine stands to transform how doctors deal with suicidal patients and depression generally.

[Discover the most compelling features and reporting from The New York Times Opinion section, selected by our editors. Sign up for the Sunday Best newsletter.]

The drug seems to address a longstanding problem in emergency psychiatry. Sedation and physical restraint aside, doctors have few ways to quickly stop suicidal ideation, or thoughts of killing oneself. The current crop of anti-depressants can take weeks and sometimes months to work, if they work at all. They may also, paradoxically, increase suicidality in some patients. Talk therapy takes time to help as well (assuming it does). Here’s a sobering fact: Some studies indicate that suicide risk peaks soon after patients have been discharged from a medical facility.

Researchers at Yale discovered ketamine’s potential as an antidepressant in the late 1990s and scientists at the National Institute of Mental Health confirmed it the mid 2000s. Numerous studies followed suggesting that the drug helps precisely with that subset of depressive patients — about a third — for whom nothing else works. It doesn’t work for everyone in this group, but when it does, it works within hours, not weeks.

Suicidality doesn’t perfectly overlap with depression. Many people attempt suicide not because they’re clinically depressed, but rather impulsively, because they’ve been fired or they’ve broken up with girl- and boyfriends, or sometimes because they’re just really drunk. I’ve heard people who show up in the hospital in this state — despondent, angry and uninhibited more than depressed — described as “drunkicidal.”

Many are fine once they sober up. For those who aren’t, ketamine may help independent of its effect on depression. And because ketamine is already approved by the Food and Drug Administration, doctors can prescribe it off-label. Meaning that not only does a drug exist right now that could help with depression and suicidality, it’s theoretically available to patients.

I kept thinking about this during the recent spate of high-profile suicides: the chef Anthony Bourdain, the designer Kate Spade, the actress Margot Kidder. Could ketamine have saved any of them? Did they know about it? Did their psychiatrists?

“More patients should be aware of this,” Louise told me. “It really is a godsend.”

Earlier this year, I wrote about ketamine and depression for Wired, and patients I interviewed told me some version of the same thing — that ketamine changed their lives and, in some cases, saved it.

Ketamine works differently from other antidepressants. The prevailing theory is that it affects the brain’s glutamate system, which scientists now realize may be involved in depression, rather than the better-known serotonin pathway used by drugs like Prozac. Animal research suggests that partly blocking certain glutamate receptors increases brain plasticity — the ability of the brain to make new neuronal connections — and corrects some of the abnormalities that result from chronic stress. These salutary effects on the brain, coupled with how quickly ketamine works, have inspired a flurry of research. A number of drugs either derived from ketamine, or based on how scientists think it works, are in development. The pharmaceutical companyJanssen is working on a nasal spray.

But ketamine has what many view as a major flaw. It can produce dissociative and hallucinatory side effects while it is being administered. Patients can feel as if they’ve left their bodies or that they’re dying. Louise described her first ketamine experience as being like Picasso’s painting “Guernica” — disjointed and unpleasant. But subsequent treatments, she said, were “wonderful” — full of images of birds, fish and whales.

Questions also remain about the safety of long-term use. Depressed patients often have to return for “booster” treatments (Louise finds that she needs an infusion once a month). The drug is considered safe when given once, but no one is sure how repeated doses may affect the brain. And ketamine can be addictive, too.

Nonetheless, dozens of clinics have opened around the country offering ketamine infusions as an off-label treatment for depression. Views on these clinics run the gamut from concerns about profiteering (Louise’s treatments cost $500 out-of-pocket; most insurance companies don’t cover ketamine when it is prescribed off-label) to acknowledgment that they may be helping desperately ill patients.

Dr. Jeffrey Lieberman, the psychiatrist in chief of Columbia University Medical Center, told the health care news site STAT that some patients may be “getting fleeced.”

Dr. Samuel Wilkinson, a Yale psychiatrist who studies ketamine, worries that some of these clinic operators forgo more established treatments to try ketamine. Case in point: Louise refused electroconvulsive therapy, because she remembers it making her mother and grandmother into “living zombies.” In Dr. Wilkinson’s view, patients should strongly consider all other reasonable possibilities before moving to ketamine. (And electroconvulsive therapy, which retains a gruesome reputation, has in fact improved greatly, he said.) He also worries that patients’ suicidal impulses could seem to disappear after ketamine treatment, leading to discharge from the hospital, but then rebound after the ketamine is stopped or tapered — something he’s seen happen in a research setting.

The deeper issue here is one of weighing the risks of new treatment that hasn’t been fully vetted and has unclear long-term side effects against a condition whose primary symptom is the urge to kill oneself.

Dr. Michael Grunebaum, a Columbia psychiatrist who studies ketamine, thinks the drug should no longer be relegated to a last-line treatment. “It makes sense that it move up in the treatment algorithm in E.R.s and inpatient units,” he told me. (Although if emergency rooms everywhere began offering ketamine, it could create new problems, he adds. As has occurred with opioids, people might claim to be suicidal when, in reality, they’re trying to get high.)

The most ringing endorsement of ketamine may come from those on the front lines of medicine: E.R. doctors. I met Louise through a doctor friend, Lowan Stewart, who works at the emergency room in Santa Fe, N.M., where she was first admitted after overdosing. He also treats patients at the ketamine clinic where Louise ended up going. Generally speaking, the protocol in emergency rooms doesn’t include giving suicidal patients ketamine, and he argues that this should change.

His view, informed by the extreme backdrop of the E.R., is worth considering. He regularly sees patients with gunshot and knife wounds, people experiencing psychotic episodes, car accident and drug overdose victims — and of course suicidal patients. Sometimes these patients beg him to kill them. Other times they threaten or attack police officers — an attempt at “suicide by cop.” Once he stabilizes them, he often has to lock them in a padded room for up to 24 hours dressed only in tearable paper pajamas, perhaps sedated, until a psychiatrist arrives. “It’s horrible,” he told me. The reality of a busy E.R. is that these patients often end up crying alone, he said.

E.R. doctors are often quite familiar with ketamine; Dr. Stewart uses it as an anesthetic regularly on children precisely because it’s considered so safe. Now that research has revealed its potential to treat depression and stop suicidal impulses, he thinks that doctors should offer it to suicidal patients in the E.R. “We could help so many people,” he said.

Moises Velasquez-Manoff, the author of “An Epidemic of Absence: A New Way of Understanding Allergies and Autoimmune Diseases” and an editor at Bay Nature magazine, is a contributing opinion writer.

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A version of this article appears in print on , on Page SR1 of the New York edition with the headline: Can We Stop Suicides?. Order Reprints | Today’s Paper | Subscribe