Ketamine and Depression

By May 16, 2018 Uncategorised

Depression is one of the most life-threatening mental illnesses in the United States today. Treatment resistant depression, which does not respond readily to talk therapy or medication — the most frequently prescribed treatments for major depression — can lead to self loathing, isolation and thoughts of suicide. Suicide is currently among the leading causes of death in America.  Even medication can have drawbacks, with first line therapies often taking as long as 6 to 8 weeks before being effective.

Faced with the long timeline of drug therapy and unwanted side effects, patients with severe depression sometimes turn to nontraditional treatments such as electroconvulsive therapy and perhaps surprisingly, ketamine therapy — a drug known as ‘Special K’ by recreational drug users. A staggering 70% of patients responded to ketamine therapy for treatment of depression in one study performed.  The study examined the use of intravenous ketamine  for depressed patients at imminent risk of suicide, and with the rapid response shown by patients, makes ketamine a potentially attractive “rescue medication” for depressed patients in need of immediate relief.

Ketamine is a newly emerging method of treatment for depressive symptoms. Best known for use as a veterinary tranquilizer and a strong dissociative when used for recreational purposes, it has demonstrated a surprising amount of success for the treatment of mood disorders. Ketamine was first approved for human use in the United States in 1970 and used extensively for surgical anesthesia in the Vietnam War.  When used to treat depression, ketamine is administered intravenously at a non-sedating dose.

Intravenous ketamine is an off label therapy available in approximately 250 clinics across the United States. Unique among treatments for depression is the ability ketamine possesses to quickly alleviate symptoms of depression, reportedly taking affect in under an hour for the average patient.  The rapid relief of debilitating symptoms can be life saving for people suffering from severe depression and suicidal ideation.

“It would be great if we could reproduce ketamine’s rapid effects in a simple oral medication. Its most exciting benefit is in treating suicidal ideation, which we currently don’t have any fast-acting therapies for; it’s an unmet clinical need that could save lives.”

– Matthew Klein, psychiatrist, University of California San Diego 

The exact method of action of ketamine has not been determined, but some researchers suspect that ketamine may encourage the brain to develop new neural connections by blocking NMDA receptors. This capacity would set it apart from all other anti-depressants currently on the market.

Ketamine therapy does have downsides as well, such as the inconvenience of accessing treatment. The limited number of clinics performing therapy as well as the cost can be prohibitive to many patients. Due to the controversial nature of utilizing ketamine for treating mental illness and its current off-label status, insurance companies are not likely to cover treatments.  The cost of an infusion can range from $800 to $2000, making therapy expensive and out of reach for many patients.

As well, ketamine therapy requires monitoring throughout treatment. The dissociative nature of the drug has not been strongly linked to psychosis in a medical setting, but due to the inherent nature of ketamine as a psychedelic and anesthetic, it is possible for patients to experience negative psychologic side effects as well. Much of what is known about ketamine and the negative side effects associated come not from supervised use in a medical setting but from recreational use.

The rapidity with which ketamine takes effect has the potential to completely change the way severe depression is treated. It is not uncommon for people suffering from depression to not seek out treatment until symptoms have become a serious impediment or until they are hospitalized. Part of the reason clinical depression boasts such a high morbidity rate currently is due to the delayed effect of anti-depressant treatments commonly used today. One dose of a typical anti-depressant is ineffectual in treating depression, unlike a dose of ketamine properly administered.

The method of administration may be one of the reasons ketamine is so effective in trials, given that it is injected directly into a patient’s bloodstreamHowever, some companies are invested in developing a method of administration that is more realistic for patients to utilize at home. Ketamine, esketamine nasal spray and other NDMA affective drugs may be hitting the market sooner than expected.