October 22, 2014

Depression Treatment with Ketamine

Ketamine Used For Depression Can Alleviate Symptoms in Just Hours

Ketamine is an anesthetic medication used in general anesthesia and even veterinary medicine. I have previously posted an article regarding the use of ketamine for treating bipolar disorder. More recent studies are showing great hope for ketamine in that it might open the door to new ways of treating depression. Recent studies now show that ketamine might be used with treatment resistant depression. In past studies ketamine rapidly reduced suicidal ideations (thoughts) in patients with bipolar depression as well. As a sidebar there is also a new medication recently approved by the FDA for treating bipolar depression with the trade name of Latuda.

I don’t use ketamine in my practice but what is exciting about this research is that ketamine takes effect in just minutes or hours and a single dose can alleviate depressive symptoms in 40 minutes and last up to 10 days. SSRIs have been known to prevent and reverse brain damage caused by depression by aiding in transforming stem cells into brain cells; this is known as neuro-genesis. Ketamine also repairs damage to the brain by rapidly aiding in the growth of new synapses and replacing damaged synapses (the connections between brain cells), and is associated with reversal of the atrophy caused by chronic stress. Ketamine is fast acting and may initially be used as a temporary medication used while starting on the SSRIs or SNRIs as these medications are building up in the blood stream during the first two weeks of treatment. Typically a benzodiazepine is used during this two week titration period. Ketamine treatment will undoubtedly be used for longer periods of treatment because of the fast acting benefits and its mechanism of action. Researchers also believe that ketamine will lead to new discoveries in fast acting treatments for depression.

An injection of the drug is the current method of delivery, nasal sprays, or possibly a patches might be the preferred method in the future to produce a fast rapid antidepressant affect in those with treatment-resistant depression. The question still remains regarding the optimal dose, and how often and how long to administer it. Once this is determined, the availability of rapid-acting antidepressants may be only steps away. Since this article was first written, much has been discussed about ketamine and its increasing use; many psychiatrists are in fact using ketamine in severe cases of bipolar depression accompanied by suicidal thoughts. They are using it because of the fast acting nature of the medication when needed in these crises situations.

Studies of Ketamine Used for Depression Treatment are Very Encouraging

Ketamine works differently than the common antidepressants. SSRIs and SNRIs and even the older tricyclics regulate the neurotransmitters in the brain. Ketamine works differently as it works on the synapses between the cells and also has an effect on replacing damaged synapses that have been destroyed by prolonged stress and depression. Ketamine offers hope to those how don’t respond to the current antidepressants as well. Nationally this percentage of treatment refractory depression is as high as 20%; however, in my Scottsdale practice I would say the percentage of people that I treat who don’t respond to the current antidepressants is much lower – near 5%. Ketamine targets the brain’s glutamate system, lifts depression, and reduces suicidal thoughts with impressive speed. Researchers at the Connecticut Mental Health Center reported the results of the first trial to assess the treatment effects of a single dose of an N-methyl-D-aspartate (NMDA) receptor antagonist—ketamine hydrochloride—in patients with depression about a decade ago. In that study, subjects with depression saw significant improvement in depressive symptoms within 72 hours after a ketamine infusion, as measured by the 25-item Hamilton Depression Rating Scale, suggesting a potential role for NMDA receptor-modulating drugs in the treatment of depression.

In 2012 scientists working at the National Institute of Mental Health on ketamine said that patients with bipolar depression given a single ketamine infusion experienced a rapid and positive antidepressant response and reduced suicidal thoughts in these patients as well. Researchers still have a way to go before ketamine can be used in depression treatment, and very few are currently using it. Potential for abuse and side effects of hallucinations are just a few of the issues that must be dealt with before this drug can be safely used for treatment.

this article on ketamine treatment is for informational purposes and not to be used in diagnosing or treating any illness
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