They’re Pushing Cut-Rate Ketamine Therapy on TikTok
“My life when I was on SSRIs and doing talk therapy: Struggling to sleep, not eating, and still feeling no relief,” the TikTok’s caption reads. A man with close-cropped facial hair and a warm, approachable face lies in bed. “Sunroof” by Nicky Youre and Dazy plays in the background. As if to emphasize the point, he tosses and turns, grimacing.
As the instrumental kicks in, the scene abruptly shifts to a busy Penn Station intersection, hues brightening like Dorothy entering Oz, the man’s face spread into a grin. “My life just the morning after Peak: More energy, well rested, therapeutic benefits within hours, no side effects, feeling optimistic,” it says.
More from Rolling Stone
Mad Genius Behind the Viral Song 'Sitting' Actually Prefers to Stand
TikTok Steroid Accounts Are Targeting Young Adults, New Report Claims
The TikTok video raises two questions: First, why would anybody be this happy in one of the most notoriously grim neighborhoods in New York City? And second, what, exactly, is Peak? The ad doesn’t say, but a quick Google search reveals that it is a “personalized psychedelic therapy program” that uses a combination of “structured wellness coaching” and psychedelic therapy to treat various mental health conditions. The handsome man in the video? He’s recently taken ketamine.
There are a slew of TikTok ads for Peak in this vein, all of which feature attractive young people raving about the impact of ketamine without actually uttering the word. (TikTok advertising guidelines specifically prohibit the promotion of controlled substances.) Many of these ads use zoomer slang to get across this message: “From saddie to baddie!” reads one emphatic tagline. These ads were precisely what drew in Nikki, a 34-year-old mom in Phoenix, Arizona, who had been struggling with treatment-resistant depression before starting Peak earlier this year.
Prior to taking ketamine, says Nikki, who asked to go by just her first name, she “had no motivation at all,” staying in bed all day and having a hard time mustering up energy for daily tasks. “It was a real struggle to be a mom, to do basic things I felt embarrassed I wasn’t doing,” she says. “It felt like my head was in a cage and I [didn’t] have a key.” After just a few sessions, she says, it was like “someone flipped a switch” inside her mind. “It was clarity,” she says. “I felt like I had clarity for the first time in a really long time.”
On social media and on its website, Peak has positioned itself as a hip, general wellness startup. The company was not founded by physicians or mental health care professionals, but by two Bay Area-based tech executives, Brandon Woo and Anh Tran, who, according to Daniel Scott, Peak’s head of community, struggled with mental health during the pandemic and “found psychedelic therapy to be something that worked for them.” (Neither Woo nor Tran were made available for an interview.)
For a two-month membership, which costs $990, Peak provides access to sublingual ketamine doses — a tablet to place under the tongue — and post-trip debriefing group sessions led by an “integration coach.” (For an additional $59 per month, Peak users can do those sessions one-on-one.) Peak’s integration coaches are not required to be licensed therapists but are there to “hold space and provide guidance,” according to Scott; qualifications include “strong verbal and written communication” and “personal and/or professional experience with ketamine or psychedelic medicine.” Indeed, of its staff listed on site, Peak does not feature a single medical doctor, though Scott says the company is “working with some people to get them on board” as they grow. “Our medical director and executive board are high-profile leaders in the fields of telemedicine and psychiatry,” he says. “We look forward to announcing the entire team later this fall.”
Peak is one of a handful of telemedicine startups that popped up during the pandemic, when the DEA relaxed its regulations regarding the transport of controlled substances. Over the past few years, ketamine in particular has experienced a huge boom in popularity, with the number of clinics across the country increasing from fewer than 60 to more than 300. In the midst of this boom, questions have been raised about the screening processes of some of these clinics, as well as the level of care provided and the veracity of the claims about ketamine’s effects. Yet the popularity of the drug has offered ample opportunity for Silicon Valley entrepreneurs looking to disrupt the exploding mental health care space.
Startups like Mindbloom and Wondermed — which also prescribe ketamine, albeit at a higher price point — have attracted the attention of Silicon Valley investors and venture capital firms, with the latter company recently announcing it had raised $4.2 million from angel investors. But the telemedicine boom has also garnered intense criticism and scrutiny from regulators, with the VC cash-flush Cerebral, a mental health care company best known for prescribing ADHD medication (which also advertised on TikTok), becoming subject to an FTC probe last June, as well as a Department of Justice investigation for possible violations of the Controlled Substances Act.
Despite the relaxed regulations, the DEA still classifies ketamine as a Schedule III narcotic. It is legal for off-label use when prescribed by a licensed clinician (it cannot be shipped across state lines, however, so startups like Peak operate only in states where they have licensed clinicians). Currently, therapeutic ketamine for depression is only approved by the FDA in the form of esketamine, one of two forms of ketamine (“R” and “S” ketamine), which is available as the nasal spray Spravato in clinics across the country.
Most doctors who prescribe and administer ketamine do so in-person and with the patient under supervision, administering the drug in either intravenous or intranasal form, to treat severe treatment-resistant depression. Peak does not do any of this. The ketamine is prescribed remotely by psychiatric nurse practitioners rather than medical doctors, following what some former patients tell me was a lax screening process; and the sessions are not supervised by a trained health care professional, with patients instead being instructed to take the ketamine under the observation of a family member or friend.
Potential risks of using ketamine include a spike in heart rate or blood pressure, or people becoming distressed as a result of its dissociative effects, explains John Keilp, PhD, associate professor of clinical psychology at Columbia medical school and research scientist at the New York State Psychiatric Institute. His clinic employs trained professionals to carefully supervise patients before, during, and a few hours after taking ketamine. What happens with Peak “just sounds like the opposite of everything we do,” he says.
Despite the concerns of the medical professionals who spoke with Rolling Stone, Peak features many glowing testimonials from patients like Nikki on its website, and as numerous patients who convene to discuss their positive experiences with the treatment on subreddits like r/therapeuticketamine. Psychiatrists and mental health care providers who spoke with Rolling Stone, however, are concerned about the popularity of telemedicine startups like Peak, which they say make grandiose claims about the efficacy of ketamine while downplaying its potential negative side effects, or may be overprescribing to patients who may not necessarily need or benefit from it. Physicians have also expressed concern about providing ketamine via telemedicine in general, arguing that the lack of oversight offers greater potential for substance abuse.
Robert Estrada, regional medical director of interventional psychiatry at the psychiatric group practice Bay Psychiatric Associates and chief medical officer of Lenox Hill Mindcare, says he is particularly concerned about Peak advertising on TikTok, which has a large user base of young people (approximately 33 percent of users are between the ages of 10 and 19, though Scott says the average Peak consumer tends to be in their late 30s or early 40s).
Of Peak’s cheerful ads, Estrada says there is a danger in depicting ketamine as a substance akin to a harmless supplement, rather than a clinical treatment. “It’s a paradigm shift in how we understand and treat depression,” says Estrada. “To have it be dumbed down and marketed to people who are just sad and not clinically depressed — that’s dangerous, for sure.”
Ketamine’s success as a drug to treat depression has taken researchers aback, in large part because it was never intended to treat depression at all; it was initially approved in 1970 by the FDA, and was used as an anesthetic for Vietnam War soldiers on the battlefield. Though it has continued to be used as an anesthetic in hospital settings, in the 1980s and 1990s, it was perhaps best known as a club drug. Over the past few decades, though, a growing body of research has determined that it could potentially be hugely beneficial for patients suffering from acute suicidal ideation or treatment-resistant depression (TRD), who have failed to respond to antidepressants or talk therapy.
“We found that if you give it to people with depression, in some cases people feel much better within a day, or within hours,” says Keilp. “This was a big surprise to people.”
Up to this point, researchers’ clinical understanding of depression treatment was based almost entirely on antidepressants. But ketamine operates via a different mechanism, and it appeared to be quite effective for many people who fail to respond to conventional drugs, with early studies of people with treatment-resistant depression showing that as many as 25 percent of patients saw improvement within the next day.
This was the experience of both Nikki and Jillian Scheel, a 30-year-old human resources manager at a cannabis tech company who came across Peak via one of their TikTok ads. Scheel wasn’t immediately entranced by Peak’s ad strategy: “It could’ve been done better,” she says, pointing out that many in the comments expressed concern that ketamine was being marketed to young people on “a children’s app.” But she was intrigued by the promise of using ketamine to treat her anxiety and PTSD, particularly at such a low price point. She was also drawn to the idea that she could do the ketamine at home, rather than getting it intravenously at a clinic. “I wanted to control as much of the experience as I could,” says Scheel. “It was a time in my life when I couldn’t control much.”
“It’s a paradigm shift in how we understand and treat depression,” says one ketamine practitioner. “To have it be dumbed down and marketed to people who are just sad and not clinically depressed — that’s dangerous, for sure.”
When Scheel told her psychiatrist she wanted to try Peak, he was initially skeptical, given that she did not have a depression diagnosis and the bulk of the research on ketamine has been focused on treatment-resistant depression. Nonetheless, Scheel was approved by Peak, and she says that taking ketamine has helped reduce her anxiety and PTSD symptoms. “I’m making good decisions and thinking rationally and not running on pure emotion,” she says. She even brought her husband along as a patient, and occasionally they will take it together.
A Peak patient we’ll call Mike, 23, who requested Rolling Stone change his name for this story, also did not have a depression diagnosis when he did his initial intake, and says that his care coordinator did not ask, though his clinician later did. He says he was “surprised” he was approved despite not having a depression diagnosis, and says during his intake session, the care coordinator listed many different case uses, including ADHD and fibromyalgia. “It seemed like a sales pitch,” he tells Rolling Stone. “She was mentioning how some people start taking it and it’s a light switch, like, ‘this is what life is supposed to be like.'” (Scott denies that Peak advertises itself as intended for anything other than depression and anxiety, though he acknowledged that “as a not licensed clinician I cannot speak to what is being said.”)
Mike says that in retrospect, it seems like the care coordinator “was pushing me towards getting it.” Nonetheless, the pitch was effective: a few days later, he received his first dose of 120 mg in the mail, which was bumped up to 250 mg the following month. He was told to have a friend or family member check in throughout his experience, so he asked his roommate to periodically come into his room during the first session, “to make sure I wasn’t dead or anything.” He didn’t have any negative effects, but he says he hasn’t had positive effects, either. “I’m willing to give it a shot for at least another month and then I’ll think about if I want to continue,” he says.
In a call with Rolling Stone, Scott said that Peak only prescribes to patients with treatment-resistant depression or anxiety diagnoses. When asked why Peak prescribed ketamine to two patients who did not have depression diagnoses, Scott says he “[couldn’t] speak to that personally,” but that Peak was focused on “not giving this to everyone.” A two-minute questionnaire on Peak’s website asks prospective patients if they are struggling with mild, moderate, or severe symptoms of anxiety or depression, though not if they have an official diagnosis; it does, however, suggest that patients who have not tried traditional forms of therapy such as antidepressants do so before seeking ketamine treatment.
There is a growing market for ketamine to be used off-label to treat other types of mental illness, including anxiety and post-traumatic stress disorder. But this has been cause for concern for some mental health professionals, who say there is simply not enough research to determine whether ketamine can be an effective treatment for other conditions. “Remember when Botox was popping up all over the country? They listed it as a miracle drug,” says Dr. Alan Manevitz, a psychiatrist in private practice who administers ketamine and transcranial magnetic stimulation for treatment-resistant depression in New York City, citing Botox’s increasing off-label usage for conditions as wide-ranging as depression and premature ejaculation. “People latch onto the latest thing because they are suffering greatly. [And] ketamine is still in that phase while we are assessing it clinically.”
A main cause for concern among mental health care providers is whether telehealth startups like Peak sufficiently screen patients during intake. In addition to questions about their medical histories, such as whether they have a healthy heart (ketamine is not recommended for people at risk of cardiac arrest), all of the doctors Rolling Stone spoke with said providers should also ask detailed questions about what other medications they are taking, and about their use of alcohol, which can be a dangerous combination.
Scheel says that, during the intake conversation, she was asked if she took benzodiazepines, and was initially rejected by Peak because she had been taking Xanax. (Benzodiazepines can interfere with the efficacy of ketamine, and also carry their own cardiac risks.) After her therapist wrote a letter indicating she had discontinued the medication, Peak accepted her. Estrada says that while he would continue to prescribe ketamine to a patient taking benzodiazepines, as long as they agreed to not take it the morning of treatment, “giving medications without a full assessment seems troubling to me.” Two of the Peak patients Rolling Stone spoke with said they were not questioned about their alcohol use nor their benzodiazepine use during the intake.
Dr. Nicole Naggar, a psychiatrist in New York City, has seen patients benefit from ketamine therapy, but notes that an ineffective screening process can have dangerous consequences. One of her patients, she says, who used another telemedicine ketamine service that (not Peak), attempted suicide after treatment. She says the patient suffered from emotional lability (or mood swings) and dysregulation, something that she believes should have disqualified them from the therapy, had the care provider asked about it. “There are a lot of adverse outcomes that people are not as well aware of. They’re desperate and they just want to get out of their depression,” she says. “I just worry for patients out there.”
In a call with Rolling Stone, Scott said that Peak’s intake process is “rigorous” and that Peak only approves patients who have been treated for anxiety and depression, with care providers cross-checking prospective patients’ names with pharmaceutical databases to ensure that they have. “It’s for people who have tried things that are simply not working,” he says.
Scott says benzodiazepines are not included on a list of contraindicated medications for potential patients. “We want to make sure we’re working with whatever the client is working with,” he says. “As long as the treatment is safe we want to be sure we’re doing it as safely as possible.” He did not know if clinicians ask patients about their alcohol use during the initial intake: “It’s not a combination we recommend,” he says. “It’s something we’d like to check on. It’s a great question. I want to say that seems like a very smart thing.” The questionnaire on Peak’s website does not ask about benzodiazepines or alcohol, though it does ask if prospective patients are “actively struggling with substance abuse” or if they have been diagnosed with psychosis or schizophrenia, things the doctors Rolling Stone spoke with say they also ask their patients. “Each patient is screened thoroughly by expert board-certified medical providers to determine clinical eligibility as well as appropriateness for telemedicine management,” says Scott. “All of our clinical monitoring practices meet or exceed similar practices that operate in the telehealth ketamine treatment space.”
“They’re desperate and they just want to get out of their depression,” says one psychiatrist. “I just worry for patients out there.”
Yet the doctors who spoke with Rolling Stone also said they were concerned about the number of doses provided to Peak patients. Though Manevitz says that ketamine is generally speaking a “very safe drug,” there have been few long-term studies done about the risks of repeated use of ketamine. A handful of studies have suggested that, at high doses, it could potentially lead to neurocognitive impairment and reduced hippocampal function when taken over a lengthy period of time. It’s unclear whether the relatively small doses administered sublingually via startups like Peak (Scott says doses range from 100 mg to 450 mg) could yield such an impact.
“In the long run, we do need to know more about what happens with multiple ketamine infusions over months and years and what the impact of that might be,” says Keilp. “We do know what the long term effects of ketamine abuse are, but we don’t know what the point we shouldn’t go past is. We just don’t know.”
In IV form, ketamine therapy is administered over the course of just a few weeks; in intranasal form, treatment is a little longer, with weekly or twice-weekly sessions over about two months. But the medical providers Rolling Stone spoke with expressed concern that ketamine telemedicine startups are financially incentivized to continue to provide the drug to clients, despite the lack of research into the effects of long-term use. Scott says this is not the case, saying that the company lowers patients’ doses after a few months to try to wean them off. He says the average patient undergoes therapy for three to six months, or in some cases eight to 12 (though it’s important to note for context that Peak has only been operational for about a year, says Scott). “We don’t recommend people use ketamine for the rest of their lives. That is not tenable or healthy,” he says, adding that the company plans to push its integration coaching services in large part for that reason. None of the patients Rolling Stone spoke with said that they had been taking ketamine for longer than a few months, but during their time with Peak, their doses had only gone up, not down, they say.
By far the largest cause for concern for mental health care providers, however, is the fact that Peak does not medically supervise the doses. At Peak, the official policy is for a patient to discuss the appropriate dose with a clinician, then have a friend or family member supervise their sessions. Given that ketamine, even at low doses, can produce strong dissociative effects, this is highly alarming, says Estrada. “This is a drug that can cause an acute confusional state,” he says, referring to the lack of monitoring as “borderline malpractice.” “At minimum, the first treatment should be supervised through telepsychiatry,” he adds. “To give someone a drug and expect them to be in an altered state and monitor their own blood pressure and call it psychedelic-assisted psychotherapy, you’re not delivering what you’re promising.” (Scott maintains that Peak’s processes are industry standard. “Commentary from anyone that doesn’t currently work with Peak or have access to our specific protocols is an overgeneralization that lacks context at its best,” he says. “Our processes are regularly reviewed and undergo quality assurance audits on a continual basis.”)
To be fair, none of the patients Rolling Stone spoke with reported having any negative side effects. Yet the strong dissociative effects produced by ketamine, let alone the potential cardiac risks, raise questions about why Peak does not supervise individual sessions. When asked why Peak does not supervise the initial session even on Zoom, however, Scott wasn’t sure. “That’s a great question,” he says. “That is something that isn’t being offered currently.” But he did claim that the initial dose patients start off at — usually 100 mg, but it varies by patient and clinician — is “low enough [that] it is not something that is cause for concern.”
The TikTok ads for Peak depict bright-eyed, bushy-tailed millennials whose lives have been forever changed by having taken ketamine. Though Scott says those ads haven’t actually been that effective (“it wasn’t successful or clear in advertising our offerings, specifically because of the word restrictions,” he says), to some degree they are accurate: the majority of the patients I spoke with say that for them, ketamine has been transformative, bordering on life-saving.
The very first time she took it, Nikki says, she did not have high expectations. Yet she followed her care coordinator’s advice and put on a blindfold and some music. She took the tablet, then sat down and closed her eyes. “I just felt joy, like a low euphoria. Pure happiness,” she says. She was immediately moved to grab a pen and paper and start doodling. Then she had a realization: “I am the one who has to bring the sunshine if I want it to be sunny.” She has since felt motivated to perform basic parenting tasks, like potty-training her toddler, which she was not at the nadir of her depression. “Basic things that were so difficult became suddenly easy, like they were nothing,” she says.
But just because ketamine shows immense promise as a treatment for people with severe depression, that does not necessarily mean that it can provide such respite to everyone. And though ketamine may be hailed as a breakthrough in our understanding of mental illness treatment, the researchers and health care providers Rolling Stone spoke with believe that’s not the same as saying it should be readily available to everyone. “It’s a slippery slope. It’s the Wild Wild West out there when it comes to ketamine right now,” Estrada says. “And this is just another example.”
The phrase “Wild Wild West” is one that recurred often during my conversations with medical professionals, the idea that Silicon Valley startups, hoping to take advantage of the relatively lax regulations for a wildly expanding mental health care market, are growing faster than they can provide support for their customers, who are often struggling with severe mental health conditions. Scott, perhaps predictably, bristles at this categorization. “A lot of alternative medicine can be said to be the Wild Wild West,” he says. “The same can be said of yoga or cannabis, outliers that become more mainstream over time. Because this is something that is becoming mainstream, there are a lot of people trying to offer ways to give people access.” He says Peak has worked hard to stay in compliance with state and federal regulations while giving people “more control over their own journey[s].” The medical professionals Rolling Stone spoke with, however, suggest that startups giving consumers the tools to take control of their own journeys may be coming at the expense of their long-term health and safety. Ultimately, it could also be harming the companies themselves, if the fate of telemedicine startups like Cerebral, which are increasingly coming under the scrutiny of regulators, is any indication. Of Peak and similar startups hoping to revolutionize the field of ketamine telemedicine, Keilp said simply this: “I hope they have good lawyers.”
Best of Rolling Stone
