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Did you know that ketamine is one of the newest possible methods for treating depression?
For a better understanding of ketamine treatment, here are explanations of what it is, how it helps depression, what types of depression it can help with, its side effects and what you can expect during a ketamine therapy session.
What is ketamine?
Ketamine is a dissociative drug, meaning its mind-altering chemical properties cause you to disconnect from your body. It was first approved by the U.S. Food and Drug Administration as anesthesia for surgery, according to the National Library of Medicine. It has been used as a street drug under different names like Special K.
Doctors sometimes prescribe ketamine for “off-label” (non-FDA-approved) uses, including for pain management and treating people who have depression and suicidal thoughts.
As of 2019, the FDA did approve a form of the drug called esketamine, a nasal spray to treat one type of depression known as treatment-resistant depression.
How does ketamine therapy help depression?
“As a human being everyone has their own default network … a person with depression or anxiety, those people tend to look at the glass half-empty,” said Dr. Keming Gao, director of the Ketamine Infusion for Depression Clinic at University Hospitals Cleveland Medical Center.
“So, the ketamine temporarily loosens up their default [network]. This whole thing is what people call neuroplasticity,” he explained.
Neuroplasticity is the ability of the brain to respond flexibly, according to the University of Utah. Ketamine has been shown to help with this by creating new neural pathways in the brain and strengthening the existing ones to make it easier to establish new ways of thinking.
According to University Hospitals (UH), with ketamine treatment, this reshaping occurs in parts of the brain that regulate mood to help you release negative thinking and reduce the symptoms of depression.
What types of depression can ketamine help with?
“We do use the ketamine infusion for bipolar depression and unipolar depression [major depressive disorder],” Gao said. “In terms of the severity, most [of our patients] are probably…at least moderately depressed and most are treatment-resistant.”
For people with treatment-resistant depression, standard treatments like depression medication and psychotherapy don't reduce symptoms, according to UH.
A review published in the British Journal of Psychiatry Open revealed that ketamine therapy showed strong, fast antidepressant effects for people with treatment-resistant depression, as well as for those with suicidal thoughts, bipolar depression and unipolar depression. However, these effects were short-lived.
Cognitive behavioral therapy (CBT) may be one answer to the temporary nature of ketamine's effects. A study published in the American Journal of Psychiatry and supported by the U.S. National Institutes of Mental Health revealed that combining CBT with just one dose of ketamine can extend the drug's antidepressant effects for 30 days or more.
How does ketamine treatment for depression work?
Gao said that prior to ketamine infusion therapy for depression, a preliminary consultation and screening are done to make sure your health and medication profile allow you to take ketamine. On the day of your first treatment, a nurse inserts an IV with the ketamine infusion. The entire session takes 40 to 60 minutes.
“The ketamine infusion is based on the body weight,” Gao explained. “The benefit is basically a stable mood. In other words, they [patients] just don't feel depressed. And some people even just feel, you know, less anxious.”
He also noted that his clinic uses a study conducted by the University of Ottawa and the Royal's Institute of Mental Health Research as a template to determine how long people should continue taking ketamine. The study found that after six treatments given over two weeks, the majority of participants had a 50% or greater reduction in their treatment-resistant depression symptoms, and 25% went into full remission.
Gao explained that once this initial treatment schedule is finished, patients can start to space out their treatments to once a week or every few weeks, depending on their needs.
What are ketamine's side effects?
According to UH, short-term side effects of ketamine include:
- Feeling dissociated or disconnected from your body
- Blurry vision
- Mood changes
- Light or sound sensitivity
Over the long term, ketamine may cause addiction, urinary and bladder problems, and liver damage.
Ketamine can also elevate the heart rate and blood pressure, according to the University of Utah, so patients with preexisting health conditions should speak with their doctors before seeking treatment.
Gao noted that in his practice, there haven't been any documented long-term symptoms yet. The most common short-term ketamine effect is “patients feel floaty on their bed … they may feel like part of the body is sort of bigger or smaller. It lasts maybe 20 to 30 minutes.”
He said the main benefit of ketamine for depression is that it can “temporarily sort of loosen up your network and makes you learn more things and [move] towards more positive sort of thinking that makes you feel better.”
SOURCE: Keming Gao, MD, PhD, director, Ketamine Infusion for Depression Clinic, University Hospitals Cleveland Medical Center
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