Depression - PTSD - OCD - Bipolar Disorder - Mood Disorders - Post Partum Depression
What is Ketamine?
Ketamine has been around since the 1960s and used primarily as an anesthetic. However, ketamine has recently gained attention in treating treatment-resistant depression better and faster than traditional anti-depressants. Patients using low dose ketamine for depression have also noted an improvement in anxiety symptoms, as well as pain relief.
Depression and anxiety are known to severely impact the quality of life and put patients at risk for suicidal ideation. The standard treatments for depression often take several months to work, at times requiring a trial of multiple agents, and frequently leaving patients under-treated. Unfortunately, many patients do not have the time nor proper providers to monitor the efficacy of these treatment options. With the assistance of ketamine and psychotherapy, we are seeing a great benefit.
How Does Ketamine Work?
Ketamine is known as a noncompetitive NMDA-receptor antagonist, and its mode of action is completely different from commonly used agents for depression, anxiety, and pain. The antidepressant mechanisms for ketamine are being studied and appear to involve targets other than NMDAR antagonism such as the interaction of calcium and sodium channels, noradrenergic and serotonergic reuptake inhibitors, cholinergic and glutamate transmission, mTOR dependent synapse formations as well as opioid-like effects. When administered, ketamine triggers a cascading sequence of events in the brain, interacting with glutamate, which is associated with the brain’s plasticity, causing changes in neurons that modulate depression. It also appears that people with depression have higher numbers of G proteins overflowing into their cell membranes, which may block the signals of cells thus contributing to symptoms of depression. These G proteins, produce cAMP, a messenger which nerve cells need to signal properly. Normally, SSRIs help to move G proteins off of “lipid rafts” on the cell membrane, allowing for better communication among brain cells and alleviating some symptoms of depression. Evidently, ketamine appears to do something similar but much faster.
Is Ketamine Safe?
Ketamine is a DEA Schedule III drug and is abused recreationally. However, when administered or prescribed in appropriate doses and by a physician, it is safe and well-tolerated. Ketamine is also easy to administer and comes in several different delivery methods.
Who is eligible for Ketamine?
We recommend considering ketamine if you or anyone you know is suffering from any of the following:
Lack of medication efficacy in severe depression cases.
Treatment-Resistant (refractory) depression
The lengthy onset of action of existing therapy
Trauma or PTSD
Severe neuropathic pain or migraines.
Who is discouraged from Ketamine treatment?
Exclusion criteria include anyone with a history of drug or alcohol dependency,
A rapidly-declining health status and current or past diagnosis of Schizophrenia or any other psychotic disorder as defined by the DSM-V such as hallucinations, delusions, and disorganized speech.
Although ketamine has been used concomitantly in patients taking opioids, dose reduction may be necessary as ketamine can enhance opioid effects. Opioid dose reduction was also seen in patients who experienced enhanced pain relief from the addition of ketamine. It is important for patients who are on opioids to be closely monitored.