What is ketamine?
Ketamine is a promising drug for treating therapy-resistant depression. Once used mainly as an anesthetic, ketamine has been found to help prevent suicide and reduce symptoms of depression through its fast acting properties. Many treatments for depression take weeks or months to be effective because the medication has to build up in one’s system in order to alter brain chemistry. With ketamine, patients can experience swift relief with just 1-3 infusions via IV, for example.
Am I a good candidate for ketamine?
Ketamine is an effective therapy for patients with therapy resistant depression (when a patient has not responded to two depression treatments). Ketamine is an FDA-approved drug however its use for depression is off-label. This is not uncommon as most one in four medications are used off-label to treat one condition, and one in three psychiatric drugs are used off-label.
Ketamine has been used to treat nearly 15,000 patients worldwide. Patients with post traumatic stress disorder (PTSD) have also been able to benefit from this therapy. The therapy is not a good option for patients with active psychosis, mania, or unstable cardiovascular disease. Nor is it good for use with children.
How does ketamine work?
Ketamine works differently from existing antidepressants. These work to affect neurotransmitter levels such as serotonin, whereas ketamine acts on glutamate, which plays a critical role in neural connections. Ketamine increases the neuroplasticity of the brain, helping the neurons communicate along new pathways. This process positively impacts mood, thought patterns, and cognition. It is also believed that ketamine may reduce signals involved in inflammation which is linked to mood disorders. Ketamine can also repair damage to the brain that is the result of long-term stress hormone impact. It also acts to reset pain receptors and block signals of pain. Ketamine works in many different ways at the same time and many studies are underway to better understand the exact mechanisms that make it so effective for treating depression and other mood disorders.
What are the benefits of ketamine therapy?
The greatest benefit of ketamine is rapid relief from depression symptoms and suicidality. Patients also do not experience some of the troubling side effects they have with typical antidepressants such as nausea, drowsiness, insomnia, and weight gain.
How is ketamine administered?
There are two therapy methods for ketamine: infusion via IV or nasal spray. The IV form of ketamine is used off-label to treat depression, whereas the nasal spray (Spravato) was FDA approved for treating depression. The dose of ketamine for treating depression is less than when it is used as an anesthetic. The effects of ketamine last for anywhere from days to weeks. Typically, it is administered in a tapering sequence, with three infusions the first week, two the second week, and once weekly for the next three weeks. The patient then moves to maintenance of one therapy a month.
What is it like undergoing ketamine therapy?
Ketamine infusions are administered by IV in the arm. Each infusion takes approximately 50 minutes and is given in a controlled manner. A low dose of midazolam is administered before the ketamine infusion to control for any potential distress. Oxygen is also given during the infusion and vital signs are carefully monitored. The patient will need to be observed for 60-90 minutes after treatment to watch for adverse side effects, including dissociation, sedation, cognitive impairment, and elevated blood pressure, and the patient is not allowed to drive or operate heavy machinery until the following day.
What are the chances of ketamine working for me?
Between 75-80% of patients feel better with this therapy compared to more traditional medications for depression (the rate for which is 35-40%). Ketamine is effective in the short term but the beneficial effects wear off after 7-10 days. Most patients have to be on a maintenance plan to continue experiencing the benefits long term. Those who respond well to the initial treatment are less likely to relapse if they continue with maintenance.
Is ketamine therapy combined with TMS a better option for me?
Studies have been done which examined the benefits of combining these two treatments for patients battling treatment-resistant depression, finding a synergistic, augmented positive effect. The studies also confirmed that long term remission of two years can be achieved.
What are the side effects with ketamine?
No drug is without side effects. The possible benefits of taking ketamine for someone who is suicidal or severely depressed may outweigh the possible risks.
Ketamine given by infusion may cause:
- high blood pressure
- nausea and vomiting
- perceptual disturbances (time appearing to speed up or slow down; colors, textures, and noises that seem especially stimulating; blurry vision)
- dissociation (sometimes called out-of-body experiences); rarely, a person may feel as if they are looking down on their body, for example.
Generally, any changes in perception or dissociation are most noticeable during the first infusion and end very quickly afterward. The nasal spray may cause the same side effects. However, the timing and intensity of those effects is different. Long-term or frequent use of ketamine may have additional side effects. More research on this is needed.
How much does ketamine therapy cost?
The cost of a ketamine infusion can range between $400-2000 and varies depending on the condition being treated, whether insurance will offset some of the cost, and other factors. You can call our office to ask about pricing.
How will the office monitor my progress with ketamine?
Our practice uses the Osmind app to monitor progress and communicate with our ketamine patients. This app allows for mood tracking so you can visualize your improvement. The doctor will be alerted if there is any regression. Learn more here.
Read more about ketamine on our research page.