There are now well over 10,000 published papers linking ketamine to mental health treatment — representing one of the largest evidence bases of any emerging psychiatric therapy. Many researchers and clinicians recognised its therapeutic potential years ago. Yet this has not translated into widespread adoption in mainstream healthcare.
A brief/rough look at the research timeline makes this clear:
| Period | Dominant Focus | Publication Volume |
| 1970–1990 | Anaesthesia; psychotomimetic effects; early psychiatry cases | Low |
| 1990–2005 | NMDA receptor & glutamate neurobiology; early mood disorder hypotheses; small pilot studies | Moderate |
| 2006–2012 | Landmark RCTs in treatment-resistant depression | Rapid growth |
| 2013–2019 | Expansion to depression, suicidality, PTSD, addiction; emergence of ketamine clinics | High growth |
| 2019–present | Esketamine approval; major trials; psychotherapy-integrated models; public health interest | Very high and still increasing |
Despite this, ketamine is still not widely available in most mental health services and those who whitness its efficacy are still having to work too hard to get it acknowledged properly.
Why?
Because ketamine is a generic medicine.
The original patents expired decades ago. No company owns ketamine. Anyone can make it.
In contrast, when a pharmaceutical company develops a new drug, they receive around 20 years of patent protection. After the long process of clinical trials and licensing, they may have roughly 10 years of market exclusivity left to sell the drug at a premium, recoup development costs, and make a profit.
Once patents expire, prices fall and the financial incentive dissolves. What remains are academic curiosity and clinicians’ motivation to help patients. This is why Prozac became the inexpensive fluoxetine we know today. It also explains why a dose of ketamine may cost only £2–£3, compared to its on-license isomer esketamine (Spravato), which sells for hundreds of pounds per dose without offering meaningful clinical advantage over its cheaper parent compound.
With ketamine, there is no period of exclusivity left.
Therefore, there is little commercial incentive to fund large-scale trials, service implementation, or national rollout, even though clinical outcomes are consistently compelling.
This does not mean ketamine is less effective or less safe.
It means the commercial model does not reward its adoption.
Meanwhile, newer patented compounds — often very similar mechanistically — attract investment and visibility not because they work better, but because they can be monetised.
For public healthcare systems like the NHS, this distinction matters.
Decision-making should be guided by efficacy and cost-effectiveness, not by the commercial viability of the molecule.
Ketamine’s generic status makes it affordable, scalable, and clinically impactful. Yet as attention gravitates toward classic psychedelics or new “neuroplasticity-enhancing” compounds, it is important not to overlook ketamine simply because it lacks the marketing power associated with patent-protected drugs.
In a publicly funded system, value and patient outcomes should lead, not patent economics.
And as commercial influence grows within healthcare commissioning, ketamine’s path to adoption becomes steeper unless we make this structural bias explicit.
Sometimes the most obvious solutions are right in front of us.
With ketamine, we already have an affordable medicine with a long-established safety profile, and by reorganising existing healthcare resources, psychedelic-assisted psychotherapy could be made accessible to the general public.
