Ketamine, once a go-to for anesthetic in operating rooms and in combat or used as a club drug called Special K, is now one of the newest tools in the arsenal for battling depression. While depression can come in varying levels, major depression is known as one of the most significant leading causes of disability across the world. In the U.S. alone, it is estimated that over 16 million people have suffered a major depressive episode during the year.
Ketamine is showing great promise as a treatment for depression, due to its ability to rapidly reduce suicidality. It has also been shown to relieve other serious symptoms associated with depression. Ketamine may also be effective at treating depression issues tied to anxiety. Previous medications can take weeks or months to be able to reduce or eliminate thoughts of depression and often need to be combined with other medications as well as therapy, ECT, or TMS. Ketamine works alone and is considered significantly more fast-acting than other options.
There are two types of ketamine that may be prescribed to treat depression. Most doctors will prescribe ketamine when they feel that their patients may have treatment-resistant depression. This means that they have not responded after two or more medications have been prescribed. The two main types of Ketamine prescribed include:
Each type of ketamine will work differently in the brain, and the delivery method will also dictate the effectiveness, as well as the side effects of each type. Research is being done to see which type will have greater or more problematic side effects.
While research is still being done to determine the potential side effects and level of effect each type fo ketamine will produce, there are side effects that have been determined. Some of these are similar to the side effects of other types of antidepressant medication. Side effects noted have been:
Most of these side effects have been pointed out with the IV infusion of ketamine. It is expected that the Esketamine nasal spray will have similar side effects, but they are still determining the prevalence and severity of the symptoms with the new method. Side effects of long-term use are still under research as well.
It is not completely understood exactly how Ketamine works to help treat depression. Initial studies have researchers believing that the ketamine targets the NMDA receptors in the brain. When the ketamine binds to these receptors, it can increase glutamate in the spaces between the neurons. When this occurs, the glutamate will then activate the AMPA receptor. When the NMDA receptor is blocked, and the AMPA is activated, other molecules will be released, enabling neurons to communicate with each other along their designated pathways. This communication process is called synaptogenesis and is believed to affect a persons thought patterns, cognition, and mood.
Researchers believe that ketamine can also help aid in the treatment of depression in other ways. It might be able to reduce inflammation in the body which has been linked to mood disorders. The multiple ways in which ketamine can aid in the treatment of depression are being studied.
Since ketamine was primarily used as anesthesia, many people are wondering if it is a safe option for depression treatment. One important thing to note is that the dosage of ketamine used for the treatment of depression is significantly lower than the dose that would be given for anesthesia. Ketamine does have addictive properties, similar to opioids, so it may not be suitable for those who struggle with addiction. You will need to discuss your doctor the risks and benefits and see if it is the right treatment option for you.
Ketamine use will not work for everyone with depression. If there is no response after the first few infusion treatments, then it is likely that your doctor will need to choose a different method of medication. If you are showing positive effects after the first couple of treatments, the repeat treatments can likely extend those positive effects though you are not likely to receive more dramatic relief after this point. There is no set standard for treatment with ketamine, so your doctor may choose to treat the acute phase and taper the ketamine off or repeat treatments over a longer period of time, stretching out the interim period between treatments.
More research needs to be done on the nasal form of ketamine to determine how best patients will respond to treatment. Research has shown that, unlike typically anxiety medications that wears off and may cause rebound anxiety, ketamine helps trigger the cortex of your brain to allow connections to regrow and create improvement over time. The body not only reacts to the ketamine, but the ketamine helps to improve and repair areas in the brain that can be affected or linked to mood and cognition.
While more research is obviously needed, many doctors and mental health practitioners are excited about the approval of ketamine to help treat severe cases of depression for those who have had little relief from traditional medications. Its ability to help relieve suicidal thoughts and repair neurological pathways provides hope for those who feel that they have no more options. Hopefully, continued research will show that the rewards far exceed the risks, and ketamine will be able to help win the battle against major depression.