In a private ketamine clinic in South Africa, adding intravenous ketamine to usual treatment for depression was associated with reduced depression severity and suicidal ideation. Among 154 patients who received ketamine infusions, 67 completed a six-infusion initial series; 60.6% responded (a more than 50% decrease in PHQ-9 score) and 32.4% achieved remission. Half of all 154 patients no longer reported suicidal ideation after treatment. Adverse events requiring intervention occurred in 6.2% of infusions, mostly nausea. Of those who completed the initial series, 48.5% continued maintenance infusions with no evidence of escalating use or abuse. This retrospective chart review is the first naturalistic study on ketamine for depressive symptoms in South Africa.
Traditional healers and psychiatrists in training follow the same basic steps when evaluating and treating a mental health patient, but the details of those steps differ greatly due to opposing worldviews. In a South African hospital ward, a traditional healer and a psychiatry trainee assessed the same inpatient. The psychiatrist used an evidence-based, naturalistic model, while the traditional healer operated from a transcendent model. Two previously unreported practices in South African traditional healing were observed: the use of a doll (effigy) and calling on angels. These differences reflect fundamentally different understandings of mental illness.