About 280 million people face depression across the globe. Among these individuals, roughly 30% have treatment-resistant depression (TRD), which generally does not improve with common antidepressants. In recent years, the drug ketamine has been used more frequently to reduce the symptoms of depression and suicidal thoughts. Though ketamine is often associated with illegal use for hallucination purposes, this dissociative anesthetic is becoming more widely used in medical settings for its robust and rapid effects.
A version of ketamine — esketamine — has even been approved by the FDA for treatment-resistant depression in adults. If you or someone you love has symptoms of depression, this guide will help you learn more about the effects and administration of ketamine as a potentially appropriate intervention.
The clinical use of ketamine was introduced in practice in the 1960s. Originally used for veterinary and anesthesia purposes, its potential for use in treating psychiatric disorders was soon discovered after reports of its fast-acting antidepressant effects. Since then, ketamine and ketamine-derived substances have been developed and used as treatment for various mental health conditions.
Ketamine has become an increasingly popular antidepressant because of its ability to target and reorganize activity in the brain. For example, a five-year study found that 55% of patients who received ketamine treatment for depression had at least 50% improvement in their depressive symptoms and quality of life. This particular study found ketamine treatment was more effective than electroconvulsive therapy (ECT), a type of electroshock therapy that is commonly used to treat severe depression. Ketamine has also been associated with treating post-traumatic stress disorder (PTSD) and substance use disorder (SUD).
Another study found using ketamine for PTSD showed promising results, reducing negative and cognition symptoms like intrusion and avoidance. Alternatively, ketamine has been used to treat SUD and was proven effective at reducing individual’s intake and craving of illegal substances, prolonging their abstinence. One study revealed a single dose of ketamine decreased the likelihood of drinking in those who struggle with addiction.
Patients who have not found improvement in their symptoms with conventional medications, such as selective serotonin reuptake inhibitors (SSRIs), may find ketamine treatment more effective because of its neurological impact. Ketamine targets different groups of neurotransmitters than these medications, particularly the glutamate NMDA receptor. Ketamine is a key player in producing a surge of glutamate in the brain, which correlates with antidepressant effects.
In addition to improving many types of mental health disorders, ketamine and esketamine have also been proven to treat suicidal thoughts and mood disorders. By targeting the glutamate system directly, ketamine helps to normalize brain function during emotionally valence processing. A study revealed patients with major depressive disorder had an increased activation in response to positive emotion after receiving ketamine treatment. Additionally, ketamine decreased activity in the brain during negative emotional conditions.
Research shows that patients who received four ketamine infusions showed significant improvement in suicidality, mood and overall psychological functioning. They also found that the patient’s symptoms of anxiety, depression and irritability were improved.
It’s important to note that the psychoactive and therapeutic effects of ketamine-assisted psychotherapy vary widely by dosage and route of administration. For instance, at lower doses, ketamine enhances glutamate production. At very high doses, it blocks glutamate and becomes an effective anesthetic. The correct ketamine dose for depression will ultimately be determined by your health care professional, but it’s generally between 1 and 4 milligrams.
As with any medication, there is the potential for side effects. These side effects may vary depending on dosage and how the ketamine is administered. Common experiences of ketamine and its side effects may include:
In rare cases, ketamine treatment may cause other adverse effects, such as:
While ketamine can be a life-changing treatment for many, it’s not for everyone. The following people may not be suited for or should be extra cautious when taking ketamine treatment for depression purposes:
However, ketamine might be a good option for you if you:
If you or a loved one are experiencing severe symptoms of depression — there is hope. Talking with your doctor will help you determine whether starting ketamine treatment is right for you. As with any treatment for a physical or mental health condition, monitoring progress and adjusting treatment is imperative. It’s important to discuss all current medications and medical conditions you have with your medical provider before starting any new treatment.
Because ketamine treatment is relatively new, many patients might not know what to expect. There are various ways a medical professional can administer this drug, including through an IV, nasal spray, oral lozenges and intramuscular injections.
IV infusions are generally considered the gold standard because of their efficacy proven by clinical trials. Additionally, IV is the only way to receive 100% bioavailability, going straight to your brain and maximizing the benefits of this treatment. However, the esketamine nasal spray, SPRAVATO™, is also common.
You can expect your ketamine treatment session to last upwards of 60 minutes, depending on your needs and whether you experience any side effects. Your provider will explain your ketamine dosing and routes beforehand, so you understand the process. Ketamine treatments are generally administered in private, comfortable settings, so you can relax. Many patients find that listening to calming music or closing their eyes makes the experience easier. Medical professionals will monitor your vitals during the infusion, including your heart rate and blood pressure.
You may experience a slight euphoric sensation or a general feeling of warmth. Ketamine is generally fast-acting, so it’s not uncommon to feel deeply relaxed right away. Note that you’ll be undergoing maintenance therapy when using ketamine. This means your infusions are spaced out over several weeks and may require multiple infusions per week for the best results.
Depression can sometimes be difficult to treat. If you or a loved one have found that conventional medications and treatments were not effective, ketamine therapy can offer help. At Principium Psychiatry, we’re committed to finding innovative and effective treatment methods that treat a range of mental health conditions, including mild and severe depression. If you’re struggling with depression, our experienced and compassionate team providers will work with you to help you find relief.
We offer SPRAVATO™ as well as IV infusion ketamine treatments. It’s our goal to help improve your overall well-being and deliver individualized care that makes you feel heard and empowered. If you’re ready to start your journey to better wellness, book an appointment to get started or contact us to learn more about our ketamine treatments.
