Ketamine for Depression: South African Psychiatrist Highlights Hope, Risks, and the Need for Safeguards
As conversations around mental health continue to grow, a new treatment option is making headlines worldwide—ketamine therapy for depression.
To help unpack the facts, myths, and concerns, Smile FM’s “The Honest Truth” recently hosted Dr. Bavi Vythilingum, psychiatrist and member of the South African Society of Psychiatrists (SASOP).
🎧 We’ve embedded the full audio recording below for those who want to hear Dr. Bavi Vythilingum’s expert advice firsthand.
Smile FM’s "The Honest Truth" recently hosted Dr. Bavi Vythilingum
Why Ketamine is Different from Traditional Antidepressants
Dr. Vythilingum began by explaining what sets ketamine apart from conventional antidepressants.
“The most important difference is the speed at which ketamine works,” she said.
Unlike traditional antidepressants—which often take two to three weeks to show results—ketamine can improve mood within a few days, sometimes even within hours.
But the difference goes deeper than timing. Ketamine targets a different brain system, focusing on the glutamate system, while standard antidepressants work on serotonin, noradrenaline, and dopamine pathways.
How Ketamine Works in the Brain
Ketamine acts on specific glutamate receptors, known as NMDA and AMPA receptors, which help stimulate rapid brain cell growth and connectivity changes.
“This is what we think triggers the fast antidepressant effect,” Dr. Vythilingum explained.
How Ketamine is Administered in South Africa
In South Africa, ketamine for depression is typically given as an intravenous (IV) infusion under strict clinical supervision.
Other forms like intramuscular injections, subcutaneous (under the skin) injections, and nasal sprays exist, but IV infusion remains the gold standard locally due to strong supporting evidence.
Who Qualifies for Ketamine Therapy?
Dr. Vythilingum was clear:
Ketamine is only recommended for people with Treatment-Resistant Depression (TRD) in South Africa.
This means individuals who have:
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Tried at least two different antidepressant medications
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Taken each at maximum tolerable doses
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Stayed on each treatment for an adequate period (typically 2–4 weeks at high doses)
What Does a Typical Treatment Plan Look Like?
Patients usually receive six infusions over two to three weeks—around two to three treatments per week.
Ketamine is not generally used as a long-term maintenance treatment due to limited long-term safety data.
Who Responds Best to Ketamine?
While research is ongoing, ketamine has shown particular effectiveness for people with severe suicidal thoughts.
“Ketamine seems to have a specific anti-suicidal effect separate from its antidepressant effect,” Dr. Vythilingum noted.
For other depression subtypes, more studies are needed to understand who benefits most.
Safety, Side Effects, and Addiction Concerns
Dr. Vythilingum emphasized the need for strict medical supervision, noting several serious risks:
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Addiction potential
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Physical side effects like ketamine bladder (painful bladder inflammation)
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Infection risks from improper injection practices
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In extreme cases: Risk of overdose and death if misused
“It’s a very potent, very effective drug—but it also carries serious safety concerns. It must only be administered by trained professionals in clinical settings,” she warned.
Legal and Regulatory Challenges in South Africa
Ketamine use for depression remains off-label in South Africa.
This means it’s not yet officially approved by SAHPRA (South African Health Products Regulatory Authority) for this purpose.
“Pharmaceutical companies need to apply for licensing, but with ketamine being off-patent, there’s little incentive for them to do so,” Dr. Vythilingum explained.
As a result, clinics offering ketamine for depression must operate carefully, often limiting public advertising and education efforts.
The Danger of Unregulated Use and Black Market Ketamine
Unfortunately, there’s a growing illegal market for ketamine, where products may be contaminated, unsafe, or misused recreationally.
“The biggest danger is that ketamine can stop breathing and cause death when taken unsupervised,” Dr. Vythilingum cautioned.
She also highlighted other dangers from non-medical use, including addiction and bladder damage.
Who Should Prescribe and Administer Ketamine?
Dr. Vythilingum explained that:
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Only psychiatrists should prescribe ketamine for psychiatric use
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Only clinicians with anesthetic training should administer it
In other words:
A psychiatrist writes the prescription. An anesthetist or similarly trained professional handles the infusion.
Costs and Medical Aid Coverage
While ketamine is not cheap, some top-tier medical aid plans in South Africa do reimburse the treatment upon motivation.
Final Word: A Life-Changing but Serious Treatment
Dr. Vythilingum closed the interview with a balanced message:
“For people with treatment-resistant depression, ketamine can be life-changing. But it must be done safely, with the right safeguards in place.”
She also thanked Smile FM for helping educate the public on both the benefits and risks of this emerging treatment.
✅ If you or someone you know is struggling with depression, please consult a qualified psychiatrist before considering ketamine treatment.