Between 15 and 20 million people are diagnosed and treated for depression every year. However, treatments like medications and talk therapy are not effective for roughly 30% of those patients. Luckily, many have found relief through new alternatives such as ketamine. As more states begin to loosen the restrictions on the medicinal use of ketamine, you may find yourself wondering if it is the right treatment for you.
History
Ketamine was originally used as an anesthetic in operating rooms, on battlefields, and in veterinary clinics. But now ketamine and its derivative, esketamine, are a new breakthrough treatment in mental health for treatment-resistant depression and major depression with suicidal thoughts. This is game-changing for those who have not experienced any success with treatments such as therapy or antidepressants. “For the first time in 60 years, we have a new antidepressant therapy that isn’t just a spinoff of existing drugs,” says Adam Kaplin, M.D., Ph.D., a psychiatrist with Johns Hopkins Medicine.
Research and Uses
In one clinical trial, 70% of patients who did not respond to other treatments improved on esketamine. This is revolutionary because esketamine triggers long-term positive changes in the brain that last beyond the duration of the drug in the system. “This accounts for why patients may maintain the benefits of ketamine treatment with one dose every two weeks, or even once a month,” according to the Yale School of Medicine. Ketamine is approved off-label for treatment for depression, treatment-resistant depression, and depression with suicidal thoughts. It has also been used to treat some substance abuse disorders. Normally, a patient has to have tried at least two antidepressants before being referred for ketamine treatment.
There are two types of ketamine used to treat major depression. One is racemic ketamine; a mixture of R and S-ketamine usually given intravenously in a doctor’s office. The other variation is esketamine, which is made from ketamine and comes in the form of a nasal inhaler known as Spravato. Spravato was FDA approved in March of 2019 for treatment-resistant depression and depressive symptoms in adults with acute suicidal ideation or behavior. This version of the treatment is meant to be taken along with an oral antidepressant, and should also be dispensed in a healthcare setting.
How Does it Work?
Though there are still questions about how exactly ketamine has a lasting effect on depression, many studies have provided scientists with strong hypotheses. Namely, ketamine seems to target MDMA receptors in the brain which increase the amount of a neurotransmitter called glutamate. Glutamate can facilitate the creation of synapses that may have been lost over the course of long-term depression. Ketamine seems to have the best results when combined with other depression treatments, such as cognitive behavioral therapy or medication. Possible side effects include high blood pressure, nausea, dizziness, perceptual disturbances, and disassociation. These side effects tend to peak at 40 minutes after treatment and usually wear off within two hours. If you have a history of psychosis or schizophrenia, ketamine treatment could possibly make psychotic disorders worse. This is also contraindicated for people who are pregnant or breastfeeding, as well as older adults with symptoms of dementia.
Side Effects and Benefits
Ketamine could have long-term effects on developing brains, and is not recommended for teenagers. Ketamine has the potential to be addicting, so it may not be the right choice for patients with a history of substance abuse. Typical antidepressants like SSRIs can have more long-term side effects like weight gain, headaches, sexual side effects, or feelings of numbness, which are not typical of esketamine. Additionally, typical antidepressants can take weeks to work properly. Esketamine takes only a couple of hours at most to begin working. SSRI’s can also worsen suicidal thoughts at the beginning of treatment, while esketamine is the only other drug besides lithium that has proven to decrease suicidal thoughtsThe research and discoveries about ketamine have been incredibly important to the scientific and psychiatric community. Hopefully, as laws and research improve, ketamine will eventually become a common and successful option for those suffering from treatment-resistant depression! It is crucial to note, again, that ketamine is most effective in combination with other treatments such as antidepressants and therapy. If you are interested in receiving virtual psychiatric care for depression or any other mental disorder, contact me today.