Albuquerque, NM -- Why is ketamine a better option for depression? How does it work compared to other therapies for depression? Read more
I’ll get straight to the point. For you or anyone you know with Severe Depression or Treatment-Resistant Depression (TRD), ease your worry. IV Ketamine Infusion may be the right therapy for you.
Researchers reviewed 24 related studies about the effects of ketamine on TRD. To name a few, they gathered studies from PubMed, Medline, and ScienceDirect. The review confirmed the role of glutamate in ketamine’s fast antidepressant effects.
The results showed notable improvement in the symptoms of depression. I’m sharing with you some of the experiences from 416 people, who participated in the various studies. These four stories come from the studies, which demonstrate the rapid effect of low-dose ketamine.
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Uplifting stories about IV Ketamine Infusionfrom people suffering from Severe Depression
STORY 1
Three people with TRD were studied through naturalistic observation in a span of 12 months. They received repeated ketamine dosage of 0.5 mg/kg. The researchers rated the severity of their depressive symptoms with the Montgomery-Asberg Depression Rating Scale (MADRS).
The three people responded positively to the ketamine therapy. Based on their own responses though, they had to go through with their individual therapy. The study showed that low-dose ketamine had a therapeutic effect on people with TRD. The study’s method though did not use other approaches. There was no random sampling, blinding, or placebo control.
STORY 2
A 49-year old woman who had a six-year history of TRD. Researchers administered ketamine intravenous infusion to her. She had it once every one to two weeks or a total of 36 doses for 10 months. Her mood stabilized the researchers noted. The severity of her symptoms was nearly reduced to 50%, too.
STORY 3
Another set of researchers conducted a random control trial study of 73 people using intramuscular injections. The researchers grouped them into two. One was the ketamine group. The other was the active placebo group. The placebo group was injected with Midazolam, an anxiolytic. After 24 hours, the researchers assessed them using MADRS. The ketamine group showed greater improvement in the MADRS score than the Midazolam group. The researchers concluded ketamine IM exhibited fast antidepressant effects.
STORY 4
The study by Murrough and colleagues was likewise confirmed in another related review. This 2019 review showed promising results of ketamine as a non-competitive receptor antagonist (NMDA) or a selective serotonin reuptake inhibitor (SSRI). Ketamine had rapid antidepressant effects on people with TRD. This is based on the review of ketamine’s clinical efficacy and mechanism of action. The researchers noted that the effects of a single dose of ketamine lasted up to one week. Two weekly ketamine infusions lasted up to 15 days.
Encouraging effects of Ketamine on people with concurrent disorders
There are two other stories from studies that show ketamine’s efficacy. It has been established as a fast-acting antidepressant for TRD. And, it’s also therapeutic for people who are at the same time suffering from suicidal thoughts or battling substance dependence.
Suicidal ideation
10 people with TRD participated in a non-controlled study. For four weeks, they received IV Ketamine doses of 0.5 mg/kg. This was done in the morning in a well-controlled medical set-up. The researchers used the MADRS and Scale for Suicide Ideation for assessment.
According to the researchers, all study subjects had a momentary increase in blood pressure. They also experienced changes in consciousness, while four of them experienced mild delusions or hallucinations. These are expected and resolved without intervention. The results of the study showed a decrease in the severity of depression after 40 minutes to 15 days.
Suicidal ideation also decreased until the seventh day. The researchers concluded that a rapid, single 0.5 mg dose of ketamine is effective in quickly lowering symptoms of TRD and suicidal thoughts.
Substance dependency
A 55-year old male patient with TRD received two ketamine infusions of 0.5 mg/kg. He was alcohol and benzodiazepine dependent as well. The researchers assessed him through the Hamilton Depression Rating Scale and the Beck Depression Inventory. The study ran for six weeks.
The results of the study revealed that on the seventh day, positive effects started to wane. But, a second infusion was effective. The researchers concluded that repeated ketamine produced positive effects on people with TRD who had a coexisting substance-use disorder.
Limitations of the Studies on Ketamine Infusion
The above-mentioned studies exhibited positive effects of ketamine on people with TRD. Most of the studies also commented they focused only on the short-term efficacy of Ketamine infusion. They recommended other researchers to examine the long-term effects of its use.
Some of the researchers also suggested further investigation of the proper practice, dosage, and intervals of administration. There’s also the question of “How many ketamine infusions are you supposed to have?” And, “When do you stop?”
What is Ketamine?
You’ve read about the good effects of ketamine. Let’s now take a closer on what ketamine is and what it’s used for. Ketamine is a substance that has anesthetic and pain killing properties. Since the 1970s, the FDA gave a thumbs up to ketamine as an anesthetic. It’s usually injected into your body during operations. It’s also used during short-term diagnostic exams.
How Ketamine works as an Antidepressant
There’s no clear explanation of how it works. Ketamine though has to do with receptors in the brain called NMDA. In our brain, there are neurotransmitters called glutamate located between spaces of neurons. Ketamine works by increasing the amount of glutamate. Glutamate works with another receptor called AMPA.
Let’s stick with the acronym as the spelled-out word is hard to remember. As I was saying, AMPA is responsible for helping neurons talk to each other in synaptogenesis. This is the process of creating a new pathway that possibly affects the way we think and feel. Ketamine may work by decreasing signals involved in inflammation linked to mood disorders, such as depression.
Symptoms of TRD or Severe Depression
Thus, ketamine works as an antidepressant due to its mechanism of action in the brain. This applies to TRD, too, based on the stories I narrated earlier. But what is depression and how is it different from TRD? The National Institute of Mental Health (NIMH) describes the symptoms of depression. Some of these symptoms are associated with the following specific behaviors:
- Excessive sleeping or the lack of it
- Irritability or mood swings
- Loss of interest in activities once enjoyed
- Hopelessness or a feeling of doom
- Extreme feeling of loneliness or isolation
- Suicidal thoughts or thoughts about death or dying
- Inability to perform self-care or activities of daily living
TRD be like…
- Experts say that TRD occurs when a person isn’t responsive to two or more different kinds of antidepressants.
- A person may not be able to tolerate the therapeutic doses of an antidepressant. This may be due to the serious side effects.
- Symptoms may become worse as remedies don’t work.
Traditional remedies for TRD
According to the World Health Organization (WHO), more than 264 million people suffer from depression globally. Moreover, WHO also mentioned that it contributes to the global burden of disease and causes disability worldwide.
Like depression, the remedy for TRD is prescription medications. Electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) are also options. It’s still best to consult your primary health care provider on your antidepressant intervention options.
Prescription Medications for TRD: pros and cons
For prescription medications, you may choose from a wide array of antidepressants and SSRIs. There’s also serotonin-norepinephrine reuptake inhibitor (SNRI) and monoamine oxidase (MAO) inhibitors. Other medications can be added to your existing antidepressant. These are called combination or augmentation therapy. Taking a cocktail of medications poses side effects for you. Moreover, what might work best for a friend, may not work for you. So, taking antidepressants can be a form of trial and error.
ECT and TMS for TRD: pros and cons
It has been the usual practice to administer ECT or TMS for TRD. Both therapies come in a series of sessions that can go on for weeks or even months. The medical community considers ECT for TRD as the gold standard.
In ECT, controlled electric current courses through electrodes attached to your scalp. You’re under anesthesia when this is done. You won’t feel the surge of electricity. You won’t get shocked either. Your brain will experience brief seizures when current is applied. This hopefully relieves the symptoms of your severe depression.
There’s a possibility of improper administration and incorrect use of the ECT equipment. So, only trained healthcare providers perform this procedure. The side effects include memory loss, nausea, headaches, and muscle soreness. The risks of heart rhythm problems may occur if you have any heart problems.
On the other hand, TMS has an electromagnetic coil attached to your forehead. It emits a magnetic field with the same outcome as ECT. You lose consciousness or experience seizures. Unlike ECT, you don’t need to be sedated. Side effects during the procedure include anxiety, mild discomfort, and skin irritation at the coil’s site. You may also experience headaches or light- headedness after the procedure.
Downsides of Ketamine
Compared to medicines, ECT, and TMS…ketamine does fairly well, too. Like any other therapy, ketamine comes with side-effects. You may experience anxiety, increased blood pressure, confusion, dizziness, and nausea.
It’s a controlled drug because it has a potential for abuse. Reckless or unmonitored use of this can lead you to psychological dependence. Although, it is physically non-addictive. If you have any history of substance dependence or alcohol use, ketamine may not be a good fit for you.
The benefits of IV Ketamine Infusion may still outweigh the possible risks. It’s becoming an accepted rapid antidepressant therapy for TRD. As more research is being conducted, the efficacy of ketamine will be further investigated. Health insurance companies do not typically cover ketamine as a therapy for TRD.
The Injection and Infusion Clinic of ABQ provides superbills to anyone interested in submitting for insurance reimbursement. We see about 5% of our patients get partial-reimbursement.
How Ketamine is administered to the Body
Ketamine for TRD is recommended when other antidepressant medications fail. It comes in two forms. There is ketamine IV infusion and S ketamine intranasal spray.
Ketamine IV Infusion
Ketamine is infused intravenously in your arm. None of it is wasted as it is delivered directly into your bloodstream. Ketamine IV infusion therapy usually takes 40 minutes as it is infused at a controlled rate.
The dose is based on your weight, response and side effects. You may be given a dose of one to six infusions before it starts to kick in. One-time boosters are needed every 3-6 weeks. The time between boosters usually increases with time.
Esketamine
In March 2019, the FDA approved Spravato or esketamine / S ketamine as an antidepressant. This form of ketamine is only the left isomer or “half” of the intravenous ketamine.
Ketamine for infusion is called “racemic ketamine”. This means it has both the left and right isomers of the medications. These isomers are chemical mirror images of each other. Spravato is packaged as an intranasal spray.
A clinician supervises you for two hours after the nasal spray is administered. This observation period is an FDA requirement. For the first four weeks, your nostrils will be sprayed twice weekly. For the next four weeks, it will be administered once a week. It becomes bi-weekly in the succeeding weeks.
As a downside of the intranasal spray, you may have a sudden urge to sneeze, cough, or gag. It may drip out of your nose or throat, instead of heading to your brain as intended. Although your out of pocket cost may be less, the overall cost is significantly more than an infusion.
Second thoughts about Ketamine?
Ketamine IV infusion and intranasal spray have its pros and cons. They’re not the first-line remedies for TRD. Rather, they are the answer to remedies that have failed. What sets it apart from the traditional remedies is its fast-acting mechanism. Ketamine provides immediate relief, which other therapies cannot do. If you are still thinking about Ketamine for you, it’s recommended you consult with an experienced Ketamine clinician.
The clinicians at The Injection and Infusion Clinic of ABQ have performed over 2,000 infusions since 2017 and all are ketamine certified. If you are looking for an experienced Infusion Clinic in Albuquerque, New Mexico give us a call at 505-445-4300
