Ketamine infusions may provide quick relief of depression symptoms for some individuals within hours, though use without prior physician consultation could prove dangerous.
Patients receiving ketamine therapy typically undergo six infusions at a clinic that specializes in its administration, with insurance typically covering esketamine nasal spray – unlike most antidepressant drugs which increase levels of monoamine brain chemicals to boost mood – this drug works differently and offers relief.
Background on Ketamine
Ketamine’s dissociative effects can provide profound mental breakthroughs and attitude shifts for patients with depression or mood disorders such as suicidal ideation. According to research released Monday, these changes can give hope and relief to people living with these conditions for years.
Ketamine works differently from traditional antidepressant medication in that it targets glutamate instead, the fastest acting excitatory neurotransmitter in the brain. By increasing glutamate transmission and creating new pathways of communication between neurons, ketamine may have antidepressant and anxiety-reducing properties.
Ketamine stands out as an antidepressant drug with rapid antidepressant and anxiety-busting benefits that may work within hours after its administration in some individuals, making it appealing to researchers, doctors, and patients. Unfortunately, however, research about ketamine remains relatively small and underfunded.
One open-label study showed that one intravenous dose of slow ketamine (0.5 mg/kg) reduced depression and suicidal ideation for 80 hospitalized patients suffering from unipolar major depressive disorder with clinically significant suicidal thoughts. Ketamine proved more effective than standard pharmacotherapy alone in helping them overcome their distress; its benefits persisted for two weeks after administration.
Another small, randomized trial compared add-on oral ketamine therapy with placebo for treating treatment-resistant depression patients. The research team discovered that more of those receiving ketamine experienced response (reduced baseline suicidal thinking rating scale scores) compared with those receiving placebo, and its benefit comparable to that of most prescribed antidepressants like fluoxetine and sertraline.
Clayton notes that while this study provides important real-world data, it doesn’t answer important questions such as how best to administer or how long ketamine treatments last and whether there are better alternatives available. She has observed many patients describing “cowboy treatments” from private infusion clinics without oversight by trained psychiatrists as she frequents online patient forums.
CDC guidelines stipulate that anyone seeking a ketamine infusion first undergo a comprehensive evaluation by a mental health provider such as a doctor or nurse practitioner, to discuss symptoms, conduct physical exams and blood tests as well as locate providers capable of safely providing it.
Methods
Ketamine offers almost immediate relief from depression symptoms, unlike antidepressants which often take weeks to work. Ketamine works by rewiring brain circuits, helping individuals think and feel differently; some researchers even claim it restores connections damaged by chronic stress. Many individuals report experiencing significant improvements after first trying ketamine treatments; therefore, it’s essential that doctors specialize in this form of medicine and prescribe it correctly.
Experts also believe a low dose of ketamine may provide relief for anxiety. More research needs to be conducted into its exact mechanisms of benefit; some researchers suggest ketamine alters how higher centers in the brain work (including parts that control emotions and self-awareness), while other research shows it binds glutamate receptors in the brain, altering their function and encouraging new neural pathways to form.
At first, taking one dose of ketamine may be disorienting for some individuals, as the infusion can send one into a dream-like state or lead to inappropriate jokes being told; others experience psychosis altogether. Most side effects are mild such as nausea and fatigue – some have even reported experiencing feelings of euphoria! Esketamine (Spravato), is the most frequently available medically supervised form of ketamine available today and approved by the FDA to treat adults who haven’t responded well to at least two antidepressant drugs. Esketamine therapy is administered in a doctor’s office or clinic with supervision by a mental health professional, where patients continue taking other antidepressant medications while receiving two weekly infusions of Esketamine during the initial four weeks, then once every other week thereafter for eight more.
Ketamine can be expensive, and some raise concerns over its administration and safety. Unauthorized providers sometimes administer it through anesthetic injections without professional guidance from psychiatrists – though some insurers may cover one infusion while requiring patients to undergo full evaluation prior to getting it.
Results from Ketamine
Studies have demonstrated that low-dose ketamine can quickly and reliably ease depression for many people with treatment-resistant depression. One randomized trial showed that infusing 0.5 mg/kg over 40 minutes proved more effective than placebo in treating at least three antidepressant drugs without success, while another study demonstrated repeated infusions were comparable to electroconvulsive therapy (ECT).
Recent research has demonstrated that ketamine can alleviate depression by changing how brain structures communicate with each other. Nerve cells involved with mood utilize glutamate as a form of communication; its receptors serve as catchers’ mitts for this chemical and help regulate mood by connecting these nerve cells together. Researchers have noted that people suffering from depression often have deactivated or weakened glutamate receptors; ketamine restocks these receptors and restores communication among nerve cells.
Ketamine typically lasts approximately two weeks before its effects become reversible, and Coulter-Scott saw that her anxiety decreased while also sleeping better at night–another common sign of depression. After six infusions of ketamine, she noticed improvements to both anxiety and sleeping quality–allowing her to take on more duties as a grandmother while reporting an improvement in overall mood.
Short-term ketamine therapy is generally well tolerated with only minor side effects such as changes to blood pressure or pulse rate. A pooled analysis of three randomized trials with up to 205 infusions involved 97 patients; two percent discontinued early due to adverse reactions.
Subsets of patients, particularly those with histories of trauma or substance use disorders, may exhibit more severe or resistant symptoms. An important predictor of response to an intravenous dose of ketamine is whether multiple antidepressant treatments and therapies have failed.
Other factors that could contribute to someone responding well to a single dose of ketamine include having higher baseline depression levels, experiencing greater dissociation during infusion, and experiencing reduced residual depressive symptoms following its use. It remains unclear as few studies have been conducted into longer-term outcomes; some patients have reported relapsing years after beginning ketamine treatment.
Should you consider Ketamine Treatment?
Ketamine works by altering how certain chemicals in the brain communicate between nerve cells. According to research, this drug appears to restore synapses – key connections that connect nerve cells – among people suffering from depression. The more synapses form over time, the stronger its antidepressant effects become.
Researchers say newly reconnected nerve cells use glutamate as a communication chemical between themselves. When given in an IV infusion via medical supervision, ketamine appears to restock these receptors, leading to better cell communication between nerves.
Numerous randomized trials have demonstrated that intravenous ketamine can quickly improve treatment-resistant depression, including suicidal thoughts, within two weeks after its first infusion. Furthermore, it also appears to provide longer-term benefits.
At an American Psychiatric Association meeting this week, an analysis of these studies demonstrated that ketamine performs at least as well as electroconvulsive therapy or ECT for treating depression in adults who had not responded to at least two antidepressant drugs; participants in this study were randomly assigned either IV ketamine treatment or three sessions of ECT each week for three weeks.
Patients receiving ketamine demonstrated significantly greater improvement on various rating scales compared to those receiving ECT, including outcomes on measures of hopelessness. They were three times more likely to have suicidal thoughts resolved by day seven compared with their counterparts who received ECT.
Other research has shown that ketamine can enhance the effects of certain antidepressant medicines when combined with them, and one small, randomized trial suggests repeated doses may work for some people suffering from depression.
However, due to its psychedelic and dissociative properties, administering ketamine should only be done under appropriate supervision by someone trained to recognize its risks. In some randomized trials, psychiatrists worked alongside anesthesiologists in administering and monitoring infusions; alternatively, it has also been administered at freestanding clinics with patients often required to continue psychotherapy as part of their ketamine treatment plan.
