Elon Musk, depression and South Africa's cowboy ketamine clinics
What's ketamine all about? Bhekisisa recently spoke with Bavi Vythilingum, a member of the South African Society of Psychiatrists, who helped write the guidelines for ketamine use to understand more about the drug and how it works. (Wikimedia)
'To be clear, I am NOT taking drugs!' the richest man in the world
The New York Times
was lying their ass off.'
Elon Musk — originally from South Africa and until recently the head of the Trump administration's so-called
'I tried prescription ketamine a few years ago and said so on X, so this [is] not even news. It helps for getting out of dark mental holes, but I haven't taken it since then,' he told
The New York Times.
Musk also
In South Africa, treatment-resistant depression is
Musk has openly talked about
Because ketamine causes temporary '
These psychedelic effects, and the fact that ketamine can make people feel happier, are part of the reason why ketamine is also used as a street drug, often known as 'Vitamin K' or 'Special K'.
Musk told The Don Lemon Show that '
In South Africa,
In 2022, ketamine
Bhekisisa
the spray isn't available in the country. Some healthcare providers in South Africa are also administering the drug
In the case of ketamine, the South African Society of Psychiatrists (Sasop) has
But
Bhekisisa's
TV programme,
Health Beat
,
Sahpra's chief executive, Boitumelo Semete-Makokotlela,
Experts say unregulated use of ketamine is not only risky — it can be deadly,
In an autopsy, authorities in Los Angeles found that
Friends
actor Matthew Perry, who played the character Chandler Bing and wrote about his
Mia Malan recently spoke to psychiatrist Bavi Vythilingum, a member of the
Bhekisisa
's May episode of
Mia Malan (MM):
Why are psychiatrists talking about ketamine right now?
Bavi Vythilingum (BV):
It's probably
MM:
Why does it work so fast?
BV:
We're not 100% sure, but we think that it's because it's
MM:
What is a
BV:
Glutamate is a brain neurotransmitter like serotonin and noradrenaline. Glutamate is situated throughout the brain and ketamine works on that receptor.
MM
: So it's something that helps you to feel good?
BV
: If you're taking ketamine, for example, for drug use, it would produce an altered state of consciousness, which can make you feel good, but can also be unpleasant. But certainly, for depression,
MM:
So who gets ketamine? Is it people who need to be helped immediately, and then you wean them off it? Or how does it work?
BV:
So there are two groups of people who would get ketamine: people who are
MM:
And if you then put such a patient on ketamine, explain to us what happens.
BV:
Most people who have ketamine will have what we call a
MM:
And for how long would that last?
BV:
For as long as we give the infusion. So usually about 40 minutes. Then they go home and they come back after two to three days for a total of about six infusions.
MM:
And what happens after that?
BV:
There's no
MM:
What about addiction?
BV:
We have to assess somebody very carefully for previous substance use and current substance use. So if somebody is an active substance user, even if they're not using ketamine — say they're an alcoholic — you'd be very cautious about giving ketamine.
MM:
Who can give ketamine? We have heard of many clinics that give it where it's not psychiatrists giving it, where a GP gives infusions. Is that legal?
BV:
It is technically not illegal, because any doctor can give any medication. That's a
MM:
What does ketamine treatment cost? And do medical aids pay for it?
BV:
You're looking at about R2 400 to R2 500 per infusion. The big cost of that is around personnel because you need an anaesthetically trained doctor and a nurse.
MM:
Do medical aids pay?
BV:
Medical aids are starting to pay. So your top-tier medical aids will pay for ketamine upon motivation, but the medical aids are reluctant to pay. And a big cause of the reluctance is all these so-called cowboy ketamine clinics. The medical aids are saying, quite rightly, that they don't know if ketamine is going to be given safely.
This interview appeared in a recent episode of
Bhekisisa
's monthly TV programme,
.
This story was produced by the
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Mail & Guardian
a day ago
- Mail & Guardian
Act now to deal with the masculinity and mental health crisis in South Africa
suicide as the fourth Death by suicide is the fourth highest cause of death among men aged 15 to 24 in South Africa. Graphic: John McCann/M&G June is men's mental health month in South Africa. The purpose is to encourage men to seek health services by promoting physical and psychological wellbeing. A report by the World Health Organisation (WHO) reported suicide as the fourth highest cause of death among men aged 15 to 24 in South Africa. Further, suicide rates are significantly higher among men than women, with 10 861 of the 13 774 suicides reported in 2023 being by men. A number of parasuicides is unrecorded. Research and practice demonstrate a correlational and causal relationship between the persistence of social ills and the prevalence of mental health conditions, compounded by poor services. Research also shows that young men are more at risk of substance use disorders, post-traumatic stress disorder, and other externalising mental health conditions. There is no evidence to prove there is a link between young people who have died by suicide and are not at institutions of higher learning and training or employed. But there is evidence that proves a close and causal relationship between social ills and mental health. One would assume this is also the case with suicide as a symptom of mental illness such as depression and substance abuse for example. This takes us to the intersection of these issues, the state of young men in our society, masculinity and mental health. In May, we learnt of the increase in youth unemployment for the first quarter of 2025. According to Statistics South Africa, 62.4% of young people aged 15 to 24 are unemployed. Further, the University of Cape Town's Southern Africa Labour and Development Research Unit reported that 30% of young people have not been in education, employment or training for the past decade. These are not just statistics, these are people with dreams and aspirations. 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The people who should be in the room are often not there. The feminist scholar, bell hooks, teaches that regressive forms of masculinity require that men suppress the emotional aspect of themselves, and if they do not do so, other men will. This is evident in state approaches to substance use, violence and crime. Understanding the family as the basic unit of society, questions are to be asked about the home circumstances under which children grow up in. What conversations are had in our homes about mental health, health seeking behaviour, emotional wellness, consent, sexuality and masculinity? Further, we must also ask about fathering and fathers in our society. Where do boys learn to be men? The State of South African Fathers report would be an important point of departure. What role does social media and technology play in shaping manhood and masculinity? In a period of pervasive manosphere, how do we influence what our children, young men and men in general see as expressions of manhood and masculinity? What are the hegemonic narratives on manhood and masculinity? One may ask: why focus on men when they cause so much harm and pain in our society? South Africa has one of the highest femicide rates globally, with about seven women to have been murdered daily. We also have one of the highest gender-based violence rates and other forms of violence against women and children. Equally, our country has one of the highest murder rates, with men being the victim in about 70% of the cases — and it is usually men who are the perpetrators. Clearly, we have a masculinity problem in our society, and we cannot continue to treat it only as a legal and policing problem. It requires all of us to act, to play a role in shaping the lives of young men. In our homes, neighbourhood, schools, sports fields, churches and all other facets of life. The Argentine social psychologist, Isaacs Prilleltensky, challenges us to build conducive social conditions of justice as a prerequisite for wellness, without which wellness becomes impossible. As mental health practitioners, we carry a social responsibility to respond to social issues. In collaboration with communities, organisations and other institutions. We all ought to collectively labour towards a just and free society, and this includes our different professions being rooted at the core of our communities and being agents of change. Siphelele Nguse is a clinical psychologist, scholar activist, and PhD candidate at Stellenbosch University.
Daily Maverick
2 days ago
- Daily Maverick
Elon Musk, depression and South Africa's cowboy ketamine clinics
Elon Musk admitted to using it for depression, Friends actor Matthew Perry died from using too much of it and in South Africa, some ketamine healthcare providers are serving it up irresponsibly. So what's ketamine all about? 'To be clear, I am NOT taking drugs!' the richest man in the world announced on his social media platform X at the end of May. 'The New York Times was lying their ass off.' Elon Musk – originally from South Africa and until recently the head of the Trump administration's so-called Department of Government Efficiency which cut billions of dollars in foreign aid – was responding to a New York Times investigation that reported he was using drugs, particularly the psychedelic-inducing drug ketamine, while he was on the campaign trail with President Donald Trump. 'I tried prescription ketamine a few years ago and said so on X, so this [is] not even news. It helps for getting out of dark mental holes, but I haven't taken it since then,' he told The New York Times. Musk also made these remarks two months ago on The Don Lemon Show. Ketamine has been used for decades as an anaesthetic drug. But in the past few years more and more psychiatrists have been using it for hard-to-treat depression – and not without reason. Peer-reviewed research, such as this study, which pooled the results of dozens of studies, shows that ketamine, when used in combination with other antidepressants, could help even the most treatment-resistant depression patients to lift their mood. In South Africa, treatment-resistant depression is mostly regarded as depression in someone for whom at least two antidepressants haven't worked. Musk has openly talked about having occasional periods of depression, but not necessarily treatment-resistant depression. Because ketamine causes temporary ' dissociative effects ', patients should only use the drug for the treatment of depression in the presence of a health professional, who either gives it to them, for instance as a drip, or supervises them taking it as a nasal spray. Dissociative effects change someone's level of consciousness or their perceptions of themselves or environment. Some patients say this feels like being 'spaced out' or 'dreaming'. These psychedelic effects, and the fact that ketamine can make people feel happier, are part of the reason ketamine is also used as a street drug, often known as 'Vitamin K' or 'Special K'. Musk told The Don Lemon Show that he gets ' a prescription from a real doctor ', but he didn't confirm whether he takes the medicine in the presence of doctors, as it should be, only that he takes ' a small amount of ketamine every other week ', with 'several weeks going by where I don't use it'. In South Africa, ketamine is registered as a 'schedule five' drug with our medicines regulator, the South African Health Products Regulatory Authority (Sahpra). Schedule five drugs can't be bought over the counter and can only be obtained with a doctor's prescription. But in the case of ketamine, a patient can also not collect the medicine directly from a pharmacy, since the taking of it for the treatment of depression has to be supervised by a health professional. In 2022, ketamine was approved as a nasal spray for treatment-resistant depression, but psychiatrists told Bhekisisa the spray isn't available in the country. Some healthcare providers in South Africa are also administering the drug off label as a drip; that's when doctors use a legally registered medication to treat an illness that it hasn't been approved for. Off-label use is a common practice for many medicines, but it has to be done responsibly. In the case of ketamine, the South African Society of Psychiatrists (Sasop), has published guidelines for its use for the treatment of depression. This includes that it's only used for treatment-resistant depression, and only in drip form, not as an intramuscular injection or as a tablet that dissolves under your tongue. Ketamine also has to be given by an anaesthetist or a GP with a diploma in anaesthetics 'in an environment where it is possible to monitor the patient and potentially resuscitate'. But Bhekisisa's TV programme, Health Beat, found many 'cowboy clinics' where unqualified workers give ketamine to people with depression and for conditions such as attention deficit and hyperactivity disorder, for which there isn't credible evidence that it works. Sahpra's CEO, Boitumelo Semete-Makokotlela, told Health Beat: '[Although off-label use] is an informed decision, on published clinical evidence, [it's important to remember] that it means that if anything happens to a patient, they [patients or healthcare providers] then cannot hold the manufacturer responsible when it, in fact, registered the product for a different indication.' Experts say unregulated use of ketamine is not only risky, it can be deadly, because if someone takes too much it can raise their blood pressure, make it hard to breathe and, among other things, cause seizures. In an autopsy, authorities in Los Angeles found that Friends actor Matthew Perry, who played the character Chandler Bing and wrote about his history of drug dependency, died in 2024 of what authorities called the 'acute effects' of ketamine abuse, which was administered intravenously. Mia Malan recently spoke with the psychiatrist Dr Bavi Vythilingum, a member of the South African Society of Psychiatrists, who helped write the guidelines for ketamine use in South Africa, in Bhekisisa's May episode of Health Beat. The interview was edited for clarity. Mia Malan (MM): Why are psychiatrists talking about ketamine right now? Bavi Vythilingum (BV): It's probably the first completely novel antidepressant that we've had for a long time. So, with antidepressants, it usually takes about, say, two to three weeks for it to work. With ketamine, you can get a response within two to three days, and sometimes, as we give the infusion patients feel better. MM: Why does it work so fast? BV: We're not 100% sure, but we think it's because it's working on the glutamate receptor and causes very big neurodevelopmental changes very rapidly, and that's what gives you that rapid onset of action. MM: What is a glutamate receptor? BV: Glutamate is a brain neurotransmitter like serotonin and noradrenaline. Glutamate is situated throughout the brain and ketamine works on that receptor. MM: So it's something that helps you to feel good? BV: If you're taking ketamine, for example, for drug use, it would produce an altered state of consciousness, which can make you feel good, but can also be unpleasant. But certainly, for depression, it seems to work for a lot of people. MM: So, who gets ketamine? Is it people who need to be helped immediately, and then you wean them off it? Or how does it work? BV: There are two groups of people who would get ketamine: those who are extremely depressed, extremely suicidal and a danger to themselves, where we need a very rapid onset of action. And the second group are what we call treatment resistant, where they have failed what we call an adequate trial – that's a trial at a high enough dose for a long enough period of two standard antidepressants. MM: And if you then put such a patient on ketamine, what happens? BV: Most people who have ketamine will have a non-ordinary state of consciousness where they may feel they are not in their body, what we call dissociation. They may experience reality in different ways. They may see complex shapes and colours. They may feel sounds as being colours. It can be a beautiful experience, but it can also be an anxiety-provoking experience. MM: How long would that last? BV: As long as we give the infusion, usually about 40 minutes. Then they go home and they come back after two to three days for a total of about six infusions. MM: What happens after that? BV: There's no internationally recognised standard of maintenance. We're still trying to understand how we should do it. But there are definitely some people who get very well on ketamine and don't get well on other stuff. And for them, we need to top up. So, initially we would top up every week to two weeks, for about four weeks, and then reassess. There are some people who need monthly ketamine, but we do that with caution, and we do a constant reassessment of a patient to see if we still need to give it. MM: What about addiction? BV: We have to assess somebody very carefully for previous and current substance use. So if somebody is an active substance user, even if they're not using ketamine – say they're an alcoholic – you'd be very cautious about giving ketamine. MM: Who can give ketamine? We have heard of many clinics that give it where it's not psychiatrists giving it, where a GP gives infusions. Is that legal? BV: It is technically not illegal, because any doctor can give any medication. That's a Health Professions Council of South Africa regulation. But you have to be within the scope of your practice, which means you have to be able to prescribe and you have to be able to manage the [possible drug] complications. Sasop's position is that only psychiatrists can prescribe ketamine because it is for either emergencies or treatment resistance situations. But we follow the principles of the South African Society of Anaesthesiologists, in that people must have an anaesthetic qualification. So I, as a psychiatrist, will prescribe, but I don't give ketamine. My anaesthetic colleagues are the people who give ketamine. MM: What does ketamine treatment cost? BV: You're looking at about R2,400 to R2,500 per infusion. The big cost of that is around personnel because you need an anaesthetically trained doctor and a nurse. MM: Do medical aids pay for it? BV: Medical aids are starting to pay. So your top-tier medical aids will pay for ketamine upon motivation, but the medical aids are reluctant to pay. And a big cause of the reluctance is all these so-called cowboy ketamine clinics. The medical aids are saying, quite rightly, that they don't know if ketamine is going to be given safely. DM
Mail & Guardian
2 days ago
- Mail & Guardian
A grandmother is a library: Support for their caregiving role is vital
About one in three children in South Africa is brought up by a grandparent.. Photo: Delwyn Verasamy/M&G) In the heart of communities across South Africa, there exists a quiet, unrecognised force holding families together: Gogo. Grandmothers are the true heroes of our nation, bringing up millions of children in the face of hardship, loss and poverty, often without support and recognition. With HIV, unemployment and other socio-economic issues having torn through the fabric of many South African households, it is frequently Gogo who steps in to care for the youngest members of the family. In fact, an estimated one in three children in South Africa is brought up by a grandparent. These women are pillars of strength, love and resilience. They nurture children with wisdom passed down through generations, instilling values, providing meals with their limited resources and ensuring their grandchildren are safe and cared for. In many cases, they are doing this while grappling with their own health problems, financial strain and the trauma of having lost their own children. Nowhere is their influence more evident than in the critical early years of a child's life. In early childhood development (ECD), the role of a caregiver is central. Studies show that the quality of interaction and stimulation a child receives in their first five years directly affects their cognitive, emotional and physical development. Gogos, though often lacking formal training, naturally embody the foundational principles of ECD through storytelling, song, structured routines and consistent emotional support. There is an African proverb that honours grandmothers: 'A grandmother is a library.' This proverb speaks to the wisdom, stories, traditions and life lessons that grandmothers carry and pass down through generations. They are living repositories of knowledge and culture. But many of these grandmothers face immense difficulties in getting formal support systems or ECD resources. Too often, they are excluded from training opportunities and community programmes because they do not fit the typical profile of an ECD practitioner. Recognising and empowering gogos is vital to the success of any community-based ECD strategy. Programmes that include grandmothers in training, provide access to parenting resources and connect them to early-learning centres can significantly boost early-learning outcomes for vulnerable children. As a nation, it is time we celebrated gogos not just as caregivers, but as educators, nurturers and community builders. They should be empowered as key partners in bringing up the next generation. Theresa Michael is the chief executive of Afrika Tikkun Bambanani, which recognises grandmothers as primary caregivers, offering them parenting resources, training and access to early learning tools.
