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What is Ketamine?
Ketamine was first introduced in the 1960s as an anesthetic. Known to produce dissociative general anesthesia, it is commonly used in surgical and obstetric procedures.
As ketamine does not compromise the functions of the heart and lungs, it is widely used in the field of critical care and pain medicine.Besides it’s use in treating medical patients, it is also sought out for it’s psychedelic effects. Users who take ketamine at low doses experience hallucinations, sedation and an “out of body experience”.
Those who are familiar with ketamine recreationally may also know it as “Special K”, “Cat Vallium” & “Super Acid”. Consequently, people who take ketamine in high doses are prone to develop bladder problems, loss of consciousness and schizophrenia-like symptoms. The recreational use of ketamine, does not negate its medical usefulness.
How exactly does Ketamine work?
Studies show that ketamine works by binding to multiple receptors in the brain. One of these includes its ability to bind to opioid receptors, which provide pain relief.Ketamine also has an affinity for the NMDA receptor, where it functions as an antagonist. The excitatory neurotransmitter glutamate primarily binds to the NMDA receptor, which plays a role in stress management.Ketamine also binds to the AMPA receptor - a part of the glutamate neurotransmission which sends signals between nerve cells. It is unclear how ketamine provides antidepressant effects in addition to its anesthetic and pain relief properties.
Researchers postulate that it may be due to its ability to bind to many different receptors and affect many parts of the body. Imaging studies of the brain show that ketamine administration increases activity in the anterior cingulate cortex and signaling in the prefrontal cortex. These outcomes are correlated to ketamine’s rapid antidepressant properties.Ketamine has proven itself to be a valuable drug in the field of medicine. It’s use as an anesthetic agent and pain relief medication make it valuable in many various medical fields. In the past decade, studies consistently highlight its role in the treatment of mental health disorders.
What are these mental health disorders and how can ketamine administration help?
Ketamine for Depression
Depression is characterized by the following symptoms:
- A persistent loss of interest
- Depressed mood with sleep disturbances
- Feelings of worthlessness
- Suicidal ideation (thoughts)
According to the National Institute of Mental Health (2019), in 2017, a major depressive episode affected approximately 17.3 million adults in the US. Only 65% of these people received professional medical treatment, while 35% did not receive any treatment at all. As the exact mechanisms of major depressive disorder are unknown, current available treatments are limited in its efficacy.Treatment-resistant depression is also increasing in incidence. In a clinical trial involving more than 2000 patients with depression, researchers monitored the symptoms and medication intake of participants for 6 weeks. The prevalence of patients with treatment-resistant depression was found to total 55%.Earlier studies have also shown promising results from IV infusion of ketamine. Patients with major depression were injected with 0.5mg/kg of ketamine, which resulted in significant improvement after only 3 days. The patients reported improvement in the two most prevalent symptoms of depression: loss of interest in activities and depressive mood.
Over the years, many studies have been conducted on the efficacy of ketamine as an antidepressant. In 2019, a single dose of IV ketamine was shown to improve severe depression and anxiety symptoms within 1 hour of administration. This effect was sustained when followed by 5 more doses in the course of 2 weeks. After a month of administration, the overall severity of depression also decreased.Researchers have also examined the effects of IV ketamine administration after childbirth. Postpartum depression - also known as “baby blues”, is characterized by feelings of emptiness, sadness and anxiety after pregnancy. In one study, a group of mothers was given a low dose of IV ketamine after childbirth. The prevalence of postpartum blues and depression was lower compared to the group that did not receive any.Perhaps the most significant effect of ketamine is its effect in suicidal ideation. Suicidal ideation is considered a psychiatric emergency, as there is currently no known medical treatment for it.
In a study involving more than 100 patients with treatment-resistant depression, one subanesthetic dose of ketamine was administered for 40 minutes. After 3 hours, the participants answered several questionnaires assessing their depression severity and suicidal ideation. The group that received the ketamine infusion showed less tendency towards suicidal ideation.Ketamine’s rapid and sustained properties have earned it the title of “miracle drug”. Despite its many benefits, it is important that patients do not attempt self-medication. As it is a potential drug of abuse, administration requires the supervision of an experienced professional in a clinical setting. For those that prefer to stay away from needles, the ideal therapy for depression also requires a multidisciplinary action involving a psychiatrist, in conjunction with other medications and cognitive behavioral therapy.
Ketamine for Anxiety
Generalized Anxiety Disorder (GAD) is a common chronic disorder that affects the adult population. It is defined as persistent, uncontrollable worrying and anxiety that causes notable distress and impairment in daily functioning. GAD affects all aspects of a person’s life - including their work and personal relationships. Standard treatment for GAD is a combination of cognitive behavior therapy and oral medications.
From initial studies that highlight the effects of ketamine for depression, researchers postulate that it may also benefit those with anxiety. This is due to the similarities in brain network activity for patients with depression and anxiety.One study involved 12 patients with treatment-resistant generalized anxiety disorders. Subcutaneous ketamine at low doses was administered to these patients at weekly intervals.
After just an hour of administration, the patients reported a reduction in anxiety that persisted until the end of the week. There were no adverse effects for this group of patients. Hence, the study concluded that ketamine can also be a potential medication for treatment-resistant anxiety disorders.
Another type of anxiety disorder ketamine can improve is Social Anxiety Disorder (SAD). SAD, or social phobia is characterized by uncontrolled fear of embarrassment, humiliation and scrutiny in public areas or situations. This fear is so excessive that it can lead to significant impairment in daily functioning. Researchers estimate that approximately 3-7% of adults in the US suffer from Social Anxiety Disorder.
Many patients with social anxiety disorder do not respond well to the current available treatments for anxiety. In one trial involving 18 adults diagnosed with SAD, researchers administered IV ketamine at 0.5mg/kg for 40 minutes. Compared to the control group, the social phobia and other anxiety-related symptoms of this group improved remarkably after 2 just weeks.
Ketamine for PTSD
Post-traumatic stress disorder (PTSD) is a disabling and chronic condition that often manifests after a traumatic incident. People with PTSD are prone to re-experiencing traumatic events, as well as possess avoidance and hyperarousal symptoms. They can also exhibit combative and detachment symptoms when triggered by something related to the inciting event. PTSD often occurs concurrently with other psychiatric conditions such as depression, alcohol abuse and anxiety.Given the proven effects of ketamine in treating anxiety and depression, the possibility that it can also be used to treat PTSD was explored. In one study, 30 US army veterans with PTSD were given six 1-hour ketamine infusions.
Their depressive and PTSD symptoms were assessed using validated questionnaires. From the questionnaire, researchers discovered that the score for both depression and PTSD symptoms decreased after the ketamine infusions. They postulated that inducing a transpersonal dissociative experience alongside intravenous high-dose ketamine was what produced the desired effects.
In another study involving patients with both PTSD and major depressive disorder, researchers administered 6 ketamine infusions at 0.5mg/kg every Monday, Wednesday and Friday. After 8 weeks, data showed a remission rate of 80% for PTSD and a 93.3% response for treatment-resistant depression. The effect for PTSD was found to have been sustained for more than a month, with no adverse effects or worsening of symptoms in the participants during the study. As a result, researchers concluded that ketamine infusions administered in a clinical setting can be beneficial for patients with PTSD and treatment-resistant depression.Even today, the exact role of ketamine in PTSD is an active field of study. As researchers continue to study the effects of ketamine, we may discover more information regarding the optimal dose, administration and indications of Ketamine for PTSD.
Currently, the FDA approves the use of ketamine for the treatment of depression at a specific dose and route, under the supervision of a healthcare provider.
One aspect that is important is the method of ketamine administration. During clinical trials, researchers often used ketamine infusions or intravenous ketamine (inserting a needle into the vein). As you’ll soon discover, how ketamine is administered is just as important as what it is used for.
IV vs Oral Ketamine
Ketamine can be administered through an intravenous, intranasal, subcutaneous, or oral route. One study explored the effects of oral ketamine, and it’s ability to exert it’s same rapid and sustained antidepressant properties. After collating several studies that used oral ketamine, researchers came to the following conclusion:
- The reduction in depressive symptoms manifested only after 2-6 weeks of taking oral ketamine, as compared to IV ketamine which only takes hours.
- Oral ketamine does not decrease suicidal ideations.
- Oral ketamine does not demonstrate improvement in treatment-resistant depression.
The authors of these studies claim that more relevant studies are needed for a robust conclusion. Omitting these claims, ketamine infusions are found to be more effective for treatment-resistant depression and reducing suicidal ideations, when compared to oral ketamine.
Some authors also add that oral ketamine is not palatable. It also has a much higher incidence of nausea. This is due to peak plasma levels not being as high as IV administered ketamine, as it would have to undergo hepatic metabolism if taken orally. Intranasal administration of ketamine can also pose several problems, as variations in the structure of the nasal cavity can affect the efficacy. Patients might also find it difficult to administer the medication themselves, which can affect the outcome.
Furthermore, because ketamine infusions are performed in a clinical setting, healthcare providers can monitor vital signs and respond as needed. This addresses complications immediately and allows the patient to focus on the experience.
Ketamine is regarded as a miracle drug in the field of healthcare. Studies have shown it to have a positive outcome on patients suffering from depression, anxiety, chronic pain, and PTSD. By binding to multiple receptors in the brain, ketamine’s effects are found to be long lasting and effective at treating mental health disorders.
The Injection and Infusion Clinic of ABQ can provide Ketamine infusions to patients!
Our team of clinicians are experienced in handling ketamine. We have completed over 2,000 infusions since 2017. We are active members of the American Society of Ketamine Physicians, Psychotherapists & Practitioners. If you’re thinking about using ketamine for medical treatment, visit us here to learn more about ketamine infusions and how it can benefit your mental health.