In the U.S., an estimated 17.3 million adults suffer from depression at least once. Many of these individuals turn to medication to cure their hopelessness, extreme fatigue and social isolation, but still struggle to control these feelings.
A recent breakthrough changed the psychiatric treatment for people who suffer from treatment-resistant depression (TRD). Small doses of ketamine, a World Health Organization “Essential Medicine,” show major developments in reversing the effects of depression.
Patients are starting to ask more questions about this form of treatment due to its increasing popularity. If you or a loved one are interested in starting treatment with ketamine and esketamine for depression, continue reading to develop a deeper understanding of this cutting-edge therapy before reaching out to a professional.
What Is a Ketamine Treatment?
Evolving from its main usage in medicine as an essential anesthetic, ketamine has increasingly become an off-label treatment for TRD. Ketamine works differently than selective serotonin reuptake inhibitors or antidepressants like Lexapro and Zoloft, because it more effectively targets and repairs the effects of depression.
Ketamine has long been approved by the U.S. Food and Drug Administration (FDA) for anesthetic purposes. Its safety profile has made it favored for treating children. Still, it awaits approval for the treatment of depression and other disorders.
Patients with TRD often turn to ketamine treatments, accompanied by psychotherapy and psychopharmacology, to ease their depressive symptoms. A trusted psychiatrist or psychiatric-mental health nurse practitioner (PMHNP) infuses small doses of ketamine to the bloodstream through an IV to give it a maximum effect.
Another form of ketamine treatment is SPRAVATO™, an FDA-approved branded kind of esketamine exclusive to licensed clinics. With this method, the patient administers the nasal spray themselves under a doctor’s supervision. Patients tend to gravitate toward this form of ketamine therapy for its less invasive quality and the likelihood of insurance coverage.
Both forms of ketamine therapy have been successful in treating depression. Some research has also indicated promising additional symptom improvements in other psychiatric disorders like bipolar disorder and post-traumatic stress disorder.
Esketamine vs. IV Ketamine
SPRAVATO™, or esketamine, is the first major antidepressant advancement approved by the FDA since Prozac in 1987. Esketamine is a close cousin of ketamine, as it derives directly from ketamine’s racemic mixture, or the mirror image of a pair of molecules that spin in different directions.
The patent for ketamine expired years ago, meaning it will cost millions of dollars to perform the clinical trials necessary to meet the FDA’s approval requirements. However, because esketamine is an altered form of ketamine, it’s possible to get it patented, leading to SPRAVATO™’s development and approval in 2019.
Intravenous ketamine therapy, used since 2010, delivers the drug directly into the bloodstream through an IV. SPRAVATO™ is less invasive, requiring the patient to administer the esketamine nasal spray themselves. Both forms of treatment have proven effective for TRD, but are exclusive to health care facilities to avoid the abuse or misuse of the drug.
Before starting Spravato treatment, the FDA requires patients to have experienced no relief from 2 prior antidepressant trials.
Initial Side Effects and Treatment Process
Ketamine for depression treatments vary, depending on the method of distribution and the patient’s unique needs. If receiving ketamine intravenously, you can expect a sequence of six infusions given two to four times per week over two to three weeks. SPRAVATO™ requires a longer sequence, given twice per week for the first four weeks, then once a week for an additional four weeks.
During your appointment, here’s what you can expect.
- Meet your psychiatrist or PMHNP: These experienced professionals are here to keep you safe and comfortable. They will guide you to your private room and stay with you throughout your treatment, ready to answer any questions you have.
- Begin your dosage: For IV ketamine therapy, your psychiatrist or PMHNP will insert your IV and begin to administer the low dose at a slow, controlled rate. For SPRAVATO™, you will self-administer the nasal spray under direct supervision. For an IV treatment, you’ll then have about an hour to sit back and relax, listen to music or enjoy a conversation with the supervising staff. For Spravato, you will spend two hours in the office, relaxing in a comfortable setting.
- Feel the relief: Some patients report feeling better the same day of their first treatment, while others take several sessions before noticing an effect. Most patients, about 70%, will respond to the medication in three to four weeks.
The ultimate goal during infusion is finding a large enough dosage to relieve depressive symptoms while avoiding the side effects. Potential side effects include:
- Mild sedation
- Decreased sensitivity or feeling
- Slight elevations or reductions in blood pressure
- Nausea or vomiting
Your doctor will discuss the benefits of using ketamine to treat depression and the side effects of treatment during your consultation.
While most insurance companies don’t cover ketamine infusion therapy, you can receive reimbursement for aspects of the treatment, such as IV placement and saline solution, through a detailed invoice. Insurance providers are more likely to cover SPRAVATO™, but coverage may vary.
How Effective Is Ketamine Treatment?
Ketamine treatments offer rapid improvement for people with TRD when compared to existing medications. Some notice benefits after their first treatment, instead of waiting weeks or even months as with other antidepressants.
Unlike other commonly prescribed antidepressants, ketamine doesn’t affect monoamine neurotransmitters, like serotonin, norepinephrine and dopamine. Instead, it acts on glutamate, the brain’s most common chemical messenger that regulates the ability to process cognitive thoughts, emotions and neuroplasticity.
In addition to this ability, ketamine can strengthen glutamate’s connections, directly influencing how people learn, remember and respond to stimuli.
Like other medications, ketamine affects every patient differently. A treatment plan of multiple doses may wear off within weeks or months, and you may then need to meet with your doctor to discuss periodic booster sessions.
Will Ketamine Change the Way My Brain Functions?
There are trillions of neural connections in the human brain, where related neurons connect to form neural networks. The brain changes in depression, caused by faulty neural connections that restrict the proper neurons from communicating.
How do scientists get these neural pathways to grow? Glutamate.
The calming neurotransmitter gamma-aminobutyric acid (GABA) is deficient in people with depression. When glutamate levels increase, GABA levels restore to “normal,” too.
We can break down the process whereby ketamine is thought to treat depression into three phases:
- Phase one: Soon after treatment, ketamine activates your brain’s opiate receptors, creating a wave of relaxation and a feeling of sedation.
- Phase two: After treatment, glutamate receptors begin increasing, causing a domino effect and restoring glutamate and GABA levels for a continued feeling of relaxation.
- Phase three: Later, when levels are stable, new neural receptors begin to grow as a reaction to the ketamine. Think of it almost like hitting a mental reset button.
Doctors have years of knowledge in the many ways ketamine changes the brain, and scientists are still making groundbreaking discoveries about the breakthrough drug. If you’re interested in learning more, talk to your doctor during your consultation to dive deeper into the science behind ketamine therapies.
Ketamine Treatment Options by Principium in Midtown Manhattan
Dr. Cohen and the team at Principium specialize in the comprehensive treatment of mood and anxiety disorders. Through numerous cutting-edge treatments, in addition to psychopharmacology and psychotherapy, our goal is to help you achieve the healthy lifestyle you deserve.
We offer IV ketamine infusions and SPRAVATO™ treatment plans tailored to your needs. Appointments take place in a private room with state-of-the-art equipment at our midtown New York City location and at our Wall Street location. If you’re ready to take the first step forward, schedule an appointment today.