A growing number of studies suggest that the use of ketamine, which is approved for use as an anesthetic, might also be helpful in areas where antidepressants have fallen short. This expanding need, and a changing perception of the value of psychedelics as medications, might explain why companies such as Nue Life, a next-generation mental wellness startup, are emerging.
Synthesized in 1962, ketamine is a newer drug compared with others in the class of psychedelics with potential for therapeutic effects. There's ecstasy, a.k.a. MDMA, which was first developed in 1912. Then came dimethyltryptamine (DMT) in 1931 and lysergic acid diethylamide (LSD) in 1938.
Ketamine therapy is gaining traction at a time when the world's mental health crisis is worsening. Between August 2020 and February 2021, the number of American adults with recent symptoms of an anxiety or depressive disorder grew from 36.4 percent to 41.5 percent, according to the Centers for Disease Control and Prevention.The World Health Organization estimates that depression affects around 280 million people across the globe.
As Nue Life CEO Juan Pablo Cappello sees it, the market need is clear because there are only subpar options available to treat mental health conditions. He explains that antidepressants relieve and mask symptoms -- not to mention that several of these medications have a laundry list of side effects.
Many options available today are indeed dated. The Food and Drug Administration approved Eli Lilly's antidepressant, Prozac, in 1987. One of the most commonly prescribed antidepressants is Zoloft, which won approval to be sold in the U.S. in 1990.
And it's no secret that talk therapy can be expensive, and many patients are not covered by health insurance. But Cappello wonders that instead of masking the symptoms with medication, is there a way to try to address the root cause of suffering and disease?
"Especially during Covid and early lockdown, we saw a huge need for helping women, veterans, and other folks experiencing symptoms of depression, and we wanted to find solutions for those who were not having success with traditional medications and treatments," he says.
Cappello's Chilean grandmother first piqued his interest in plant medicine and indigenous traditions. That interest would not be a fleeting one. Cappello, who is a lawyer by trade, spent the past 20 years supporting psychedelic research. And, after digging into research on psychedelics and wearable tech, Cappello and his team "envisioned combining the two to create a personalized treatment plan that can drive profound change."
And so Nue Life was born.
The company is funded by the likes of Jack Abraham, of Atomic, and Jon Oringer, of Shutterstock. Right now Nue Life offers at-home ketamine therapy, but plans to expand its offering as research and legislation evolve. The company is not associated with any research institutions or hospitals.
Here's how it works: Prospective patients contact the company through the app or by phone for a telemedicine consultation. After undergoing what the company says is a rigorous screening process, candidates for the therapy are prescribed oral ketamine and Nue Life sends a single dose to the patient's house. The patient is required to have a physical sitter who will monitor the ketamine experience with them, which lasts about two hours on average.
"Ketamine is a very safe and effective drug, but it is critical to us that someone has a personal sitter," Cappello says. Sitters must go through an online training course, though nurse practitioners are also available on demand should a sitter have any questions or concerns. Ketamine got FDA approval as an anesthetic in 1970 but has yet to receive approval to treat depression and other conditions. But, more recently, the nasal spray Spravato (a close relative of ketamine) snagged FDA approval in March 2019 for use with treatment-resistant depression.
But ketamine is not without notoriety. Some know it as a horse tranquilizer, others recognize the drug as "Special K," because of its recreational popularity among the rave and club scene. At high doses, the drug can induce seizures or send users down so-called "K-holes," where some describe out-of-body experiences. It's also a known date rape drug. But in low doses, it can relax the mind and alleviate pain. Research suggests that ketamine can increase the production of the neurotransmitter glutamate, which helps neurons regrow lost connections. To date, Nue Life has arranged 22,500 ketamine experiences with no serious negative outcomes.
The company offers two programs, according to its webpage. A one-month program includes six ketamine experiences, which runs $1,250. The four-month program offers 18 ketamine treatments for $2,750.
Doling out ketamine to patients is only the first part of the treatment; the second is to then use data and A.I. to recommend next steps. "The real mission is to leverage those experiences to help [patients] do the deep work necessary to heal the underlying root cause of trauma and disease," Cappello says.
Nue Life measures patient outcomes through data collection, and more data means better patient recommendations. That's where the A.I. comes in. For instance, the A.I. incorporated into the Nue Life platform might recommend that a patient check in with their psychotherapist and offer to schedule a therapy session through an online tool. It also uses digital phenotyping, a process that pulls data from smartphones and other devices to study patterns in behavior. The company obtains prior consent before connecting its app to a patients' wearable devices.
Digital phenotyping can help Nue Life validate subjective responses of its patients before and after ketamine therapy by looking at the digital markers of depression, anxiety, and PTSD, the company says. If a patient says they're doing well, but in reality they're not sleeping, exercising, or interacting with their phone in a healthy manner, then the company is able to probe its patients a little bit deeper. "Tech can be a tool that allows us to deliver more effective and personalized experiences to our patients," Cappello says.
A big-picture question, and an obstacle for Nue Life as well as other companies in the space, is how long will it take for society, law enforcement, and regulators to overcome the stigma that's associated with drugs like ketamine. But as more companies, such as the German startup Atai Life Sciences, get the green light to conduct clinical trials examining ketamine and depression (Atai is using a non-psychedelic form of ketamine), these treatments will likely grow in popularity. And the segment is developing, with at least one forecaster pegging the addressable target market for psychedelics in the realm of $10.75 billion by 2027.
"The need and opportunity have never been greater for a new approach to mental health, focusing on deep healing," Cappello says.