Ketamine is a new type of treatment for depression, only available for the last few years. In 2006, ketamine was found to provide fast dramatic reduction in depression symptoms for treatment-resistant patients. Since then, numerous studies have consistently repeated the same results.
So what is ketamine? An old drug, it’s been used for decades as an anesthetic or tranquilizer. But now ketamine has become an increasingly important part of the mental healthcare arsenal, especially for treatment-resistant depression.
How it Works
So why is ketamine so unique? Ketamine, unlike any other antidepressant, works primarily on the glutamate system. Specifically, it works as an antagonist (or blocker) at the NMDA glutamate receptor. Downstream effects include increases in BDNF (brain derived neurotrophic factor), which triggers growth of new neuronal synapses. This growth is thought to underly ketamine’s quick antidepressant action.
How Effective is it?
Numerous studies have proven ketamine’s efficacy in high quality clinical trials. Although ketamine can provide quick relief of even the most severe depression, it does not always work.
Overall about 65% of people with treatment-resistant depression respond (i.e. at least a 50% improvement). The other 35% have a smaller improvement, or no improvement at all.
Fortunately, it is faster to do a trial of ketamine (compared to typical antidepressants), so it does not take as long to find out if someone will respond or not.
What Other Options are There?
If ketamine does not work, or if it is not the right choice for you, there are many other options for treatment resistant depression. One of these is continuing medication trials with different medications. Unfortunately, once you have not responded to 2 standard medications, the chance of response goes down dramatically, to about 15%. At this point, it may be appropriate to consider several other treatment options as well:
transcranial magnetic stimulation or TMS
electroconvulsive therapy or ECT
vagus nerve stimulation (VNS)
esketamine (Spravato) (link to esketamine page)
We do not provide TMS, ECT, or VNS at our office, but we refer to other local providers who deliver these services. (However, VNS is very difficult to find, and we are often unable to find an appropriate referral for this treatment.)
What is the Process Like
at Our Office?
At LBH, the process starts with a screening phone call for you to gather information and explain your symptoms and treatment history. Following this, you will be scheduled for a formal evaluation with one of our licensed providers within a few days. During this psychiatric evaluation, you will meet one on one with our professional psychiatric provider to understand your history and make a diagnosis. At the end of this process, we will review our findings and discuss treatment recommendations. If ketamine is recommended, we will also review more details about the risks and benefits of ketamine treatment.
Upon starting treatment at LBH, patients will be welcomed by the caring staff, then escorted to a private treatment room. Ketamine will be given intravenously as a 40 minute infusion in a calm, quiet environment. During this time, your vital signs will be checked and staff will monitor your progress. Afterward, you will be able to recover peacefully as the medication gradually wears off. The whole treatment process typically lasts about 90 minutes.
What Does Ketamine Feel Like?
Patients typically experience some type of change in their state of awareness and perceptions during the infusion, an effect known as dissociation. Patients may feel like they are floating or detached from their body, or a variety of other unusual perceptual experiences. During the ketamine-induced dissociation, there are often some unexpected thoughts and feelings, such as a type of detachment allowing thoughts of difficult experiences with a different perspective. Many patients have described this as a helpful experience due to the difference thoughts and feelings they experienced. are also described by patients during this state. Therapists sometimes report find that patients can process issues in a different, helpful way after a ketamine session. Unfortunately, these effects are not well delineated, and there is not good consensus on how much they may or may not contribute to the depression improvements ketamine provides.