Two Decades of Data

People frequently ask us questions at Frequency Healing about why their doctor or mental health provider has never mentioned ketamine therapy as an option that could help their depression.  We also get questions about why insurance frequently does not cover the cost of infusions, a reality that makes treatment with ketamine very difficult to obtain for many people.  The answers to these questions are not straightforward or simple.  When we consider that we have two decades of data supporting the use of ketamine as an effective treatment for treatment resistant depression, the lack of access to this treatment is confusing, especially when we consider that only an estimated 60-70% of depression patients respond to conventional treatment with SSRI medications and 10-30% experience treatment resistant depression [1].  If we have a treatment for this 10-30% of patients, why do providers not tell patients about it and why do insurance companies not pay for it?  Ketamine, when given by the intervenors or intermuscular route, is a FDA approved medication for anesthesia. It can be used “off label” for depression because it does not have specific FDA approval for this treatment.  However, a newer preparation of ketamine that is self-administered as a nasal spray, known by the trade name Esketamine, does have FDA approval for treatment resistant depression, though it is also expensive and frequently not well covered by insurance companies and many mental health providers do not prescribe it.  

Why is this?  

While there are many factors contributing to these issues, one reality to consider is the manner in which change occurs in healthcare.  According to a theory about adoption of change known as Diffusion of Innovations, developed by an Ohio State University Professor named Everett Rogers, there are five main categories of “adopters” when it comes to adopting new innovations.  While not limited to innovation in healthcare, this social phenomenon is a useful lens in which to view ketamine’s adoption as a mental health treatment.  

The five types of adopters as outlined by Rogers are Innovators, Early Adopters, Early Majority, Late Majority, and Laggards.  The names of these different groups describe them quite well as the Innovators are the minority that pioneer new ideas, technology, and treatments; these are often the people doing the research.  Then, a slightly higher number of Early Adopters will learn about a new idea or new data and eagerly implement the new technology or treatment.  As evidence mounts to the efficacy of a treatment or technology, even more people will be inclined to adopt the technology and this group makes up a majority split into two parts, both Early Majority and Late Majority.  This where most healthcare providers fall into this theory.  Finally, the group that is the last to embrace a change and can even at times be recalcitrant about doing so, is known as the Laggards [2]. 

In this model, clinics like Frequency Healing really are still part of the Early Adopters group but as more healthcare providers become familiar and open to ketamine treatment, they will start to become an Early Majority.  Other providers will naturally come along later as data becomes more robust and harder to dispute.  Unfortunately, Insurance Companies are often found in the Laggard group when it comes to implementing change.  As a result, we can expect coverage and reimbursement for ketamine treatment to continue to be a challenge for some time. 

Change in healthcare takes time and patience. What can we do about this reality?  While it is at times frustrating to be part of the Early Adopters group or a patient looking for a provider or a way to get the care they need, what we need to do is continue to share our stories, conduct valid research, and do our best to increase access to care.  It feels like an uphill battle at times, and when we look at the curve that describes the Diffusion of Innovations visually, we can see that once we get to the top of the curve, it’s all downhill from there!

1. Al-Harbi KS. Treatment-resistant depression: therapeutic trends, challenges, and future directions. Patient Prefer Adherence. 2012;6:369-88. doi: 10.2147/PPA.S29716. Epub 2012 May 1. PMID: 22654508; PMCID: PMC3363299.

2. S. Sutton, in International Encyclopedia of the Social & Behavioral Sciences, 2001. Accessed at https://www.sciencedirect.com/topics/nursing-and-health-professions/rogers-theory