nurse setting up an IV 1000 x 667

nPeople suffering from depression aren’t alone. In fact, depression is one of the most common mental health issues in the United States today, with nearly 15.7 million American adults suffering from these feelings of persistent sadness and irritability. More than 300 million people experience depression worldwide, according to the World Health Organization. Untreated, depression can become a chronic debilitating disease, leading to anxiety disorders, eating disorders, substance abuse issues, heart disease, and even suicide.

We see patients who suffer from severe depression and have exhausted nearly all conventional treatments including oral medications, psychotherapy, behavioral therapy, and electroconvulsive therapy.

Fortunately, there’s new hope for healing severe depression and improving lives—and it’s called ketamine infusion therapy. Ketamine is an anesthetic medication that, in traditional doses, has been used for more than 50 years to sedate adults and children in emergency and operating rooms. In recent years, ketamine has emerged as a very safe, rapidly-acting, and effective alternative for treatment-resistant depression. In fact, ketamine has been touted as one of the most significant advancements in treating certain treatment-resistant chronic diseases including:

  • Depression (including postpartum depression)
  • Obsessive-compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD)
  • Generalized anxiety disorder (GAD)
  • Bipolar disorder (manic with refractory depression)
  • Fibromyalgia
  • Complex regional pain syndrome (CRPS), also called reflex sympathetic dystrophy (RSD)
  • Neuropathic pain
  • Migraine headaches/Persistent daily headaches

 

How ketamine infusion therapy works

Simply put, ketamine improves and rebuilds synaptic connections in the brain.  Traditional oral antidepressants can take weeks or even months to reach therapeutic levels, and only half of all patients get relief from their symptoms. As a NMDA receptor antagonist, ketamine has a positive effect on the neurotransmitter glutamate. Emerging evidence has linked depression with dysfunction in this neurotransmitter. Research has shown that subanesthetic doses of ketamine not only produces a rapid and robust antidepressant effect where it can lift depression in many patients within hours, but it also can put a quick end to suicidal thinking.

Ketamine is a very safe drug with few side effects. As anesthesiologists, we regularly administer this medication and are specifically trained to monitor and respond to its effects. With low doses of ketamine, side effects can include feelings of euphoria, confusion, dizziness, drowsiness, fuzzy vision, and nausea. These side effects clear up quickly, within approximately 10-15 minutes after completion of the infusion. There are no long-term reported side effects with ketamine infusions.

The majority of the patients see some mood elevation and symptomatic relief between the first and second infusion. If the infusions are effective, a series of four additional infusions are scheduled over the following 10 days. After that, maintenance “booster” infusions may be scheduled weeks/months later to maintain a positive response. Each patient is unique, so the dosage, frequency, and total length of treatment can vary and is customized to maximize the most effective sustained response.

 

Research shows it is changing lives for the better

A recent study, which was published May 3rd in Scientific Reports, reinforces ketamine’s reputation as an effective antidepressant both as a monotherapy and adjunctive therapy. Researchers at Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California San Diego mined the FDA Adverse Effect Reporting System (FAERS) database for depression symptoms in patients taking ketamine for pain. They found that depression was reported half as often among the more than 41,000 patients who took ketamine, compared to patients who took any other drug or drug combination for pain. The team found that the incidence of symptoms of depression in patients who took ketamine in addition to other pain therapies dropped by 50% compared to patients who took any other drug or drug combination for pain.

We’re seeing similar positive outcomes with our patients with 7 out of 10 patients reporting a positive response. In the past six months, we’ve administered more than 200 infusions to patients who were referred to our clinic after having exhausted all other treatment options including electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), psychotherapy, and multiple oral drug therapies. The ketamine infusions, coupled with our team of caregivers working in close coordination with the patient’s current care team, have proven to be truly remarkable in providing effective relief.

As an example, one of our patients thought about suicide more than 1,000 times per day, and, after the second infusion, her suicidal thoughts nearly completely disappeared. It stayed that way for almost three months before she chose to return for a single maintenance “booster” infusion.

 

Setting the record straight

There are some controversies surrounding the use of ketamine, which has been known to have a reputation as an illicit party drug (with a street name of “K” or “Special K”) due to its hallucinogenic effects at high doses. Like many drugs, if abused and misused, there can be harmful side effects with the potential to overdose. But current studies do not demonstrate an addictive potential for ketamine infusion therapy. We mitigate the risk of abuse by limiting access to the infusions and instead of sending patients home with oral medications, our trained health care providers are providing ketamine in a medically supervised clinical environment. This approach greatly minimizes the potential for addiction and misuse.

There is an additional concern with using ketamine infusion therapy because although the U.S. Food & Drug Administration (FDA) has only approved this medication for anesthetic purposes, it has not yet been approved for its use in treating chronic conditions such as depression. It is said that ketamine has never been tested for its safety and effectiveness in treating depression in a large-scale clinical trial due to financial reasons and the ethical controversy surrounding the misuse of it.

If more research can continue in this field, including large-scale clinical trials, ketamine infusion therapy may transform the way the public and other medical professionals think about treating depression, and it could open the door to even more effective forms of treatment.

 

Find the right, multi-faceted treatment

Not all people who suffer from the chronic diseases we’ve mentioned will respond to ketamine infusion therapy, and even those who are responders from this therapy may require a multi-faceted approach for a comprehensive treatment plan. Ketamine infusion therapy may not be a “silver bullet” treatment to heal depression. As caregivers, we need to address all aspects of a person’s disease, including social, environmental, biological, and psychological considerations. However, for some patients, ketamine infusion can be the long-awaited solution to return to a good quality of life.

Those who have one of the chronic diseases mentioned, and feel they’ve exhausted all treatment options, should talk to their primary care provider about whether ketamine infusion therapy may be the next step in their care.

Sources:
A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders, JAMA Psychiatry, March 1, 2017.

Editors note: An additional reference on the topic was published 8/14/17. Here is the link:

Considerations on the Off-Label Use of Ketamine as a Treatment for Mood Disorders

1 COMMENT

  1. I never knew until you shared that ketamine is helpful in treating psychiatric illnesses such as depression and anxiety disorders by means of working through the synaptic connections in the brain and transmitting anti-depressant effect to the patients. This sure is a great breakthrough in science and another way of justifying the saying, “it’s all in the mind.” Most people act on extreme ways to get over it without realizing the feeling of fulfillment and achievement when you overcome such challenge. This information sure is something that I will keep in mind especially in cases when we know someone who is suffering from depression and other psychiatrical conditions.

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