What Are The Different Ways You Can Take Ketamine
For therapeutic purposes, ketamine can be taken via intramuscular injection, intravenous infusion, orally , or nasally . More research is needed to determine which method is the most effective. Generally, only the tablet, like the kind I take, is self-administered , and the rest are administered by professionals in a clinical setting.
Ketamine For Depression: What Is The Right Dose For Me
A new study released in October in Molecular Psychiatry explored what the optimal ketamine dose is for its use as an antidepressant. Most studies that have looked at ketamines ability to rapidly reduce depressive symptoms and suicidal ideation used 0.5mg/kg over 40 minutes as the target dose, and lower or higher doses had rarely been studied before this article. Researchers at Massachusetts General Hospital and five other US medical centers compared four different doses of intravenous ketamine among 99 adults in outpatient treatment for treatment-resistant depression. In this study, treatment-resistant depression is defined as failed to respond satisfactorily to at least two adequate courses of treatment during their current depressive episode.
The study showed that the higher dose was no better than the standard dose in terms of depressive symptom reduction, but the standard dose was tolerated better with less side effects, dissociative symptoms, and transient high blood pressure. Conversely, the lower dose was extremely well tolerated but for some patients it was less effective.
If you would like to learn more about ketamine treatment for depression, ketamine infusions in New York City, or to schedule an evaluation, please call Principium Psychiatry, located near Columbus Circle in Manhattan, at 212-335-0236.
For Patients Most In Need
Currently, for patients who are very depressed, potentially suicidal and not responding to currently available antidepressants, the next step is to offer electroconvulsive therapy or transcranial magnetic stimulation , Dr. Anand says. These treatments use electric currents and magnets, respectively, to stimulate nerve cells in the brain.
ECT is a time-tested, effective treatment which can make people come off the depression in matter of days or a few weeks. But it comes with its own set of undesirable side effects.
You have to be put under general anesthesia for ECT, andsome people complain of memory problems afterward, he explains. It also has asocial stigma attached to it.
Dr. Anand is hopeful that esketamine can become an easieralternative to these treatments when a quick response is required. Hescurrently the lead investigator on a large multi-site clinical trial thats testingout whether ketamine infusions are as effective as ECT therapy for these patients.
Up until now we didnt have anything except ECT for patients who are suffering and who are not responding to the other medicines, he says. Ketamine can probably give us one other option to use to get people better quickly, and this wont involve any anesthesia and probably wont cause any memory problems.
Image at top courtesy of Janssen Pharmaceuticals.
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What A Ketamine Trip For Depression Is Really Like
Treating depression with the former party drug is a major development in psychiatric medicine, and now you can even do it from the comfort of your home.
Leaving the house before the pandemic was hard enough, thanks to my social anxiety and depression. But once lockdown started? Forget about it. Being in quarantine exacerbated my symptoms until, one day, I realized that I was practically bed-bound. From eating and working to binge-watching and texting, I did it all in my bed.
I was on antidepressants, and my depression was worse than ever.
While I’d heard good things about ketamine therapy, I figured it was too pricey, and the idea of going to an actual brick-and-mortar clinic was beyond me in my depressed state. But Google was onto me: I was served an ad for Mindbloom, an at-home ketamine treatment company.
When I looked it up, the cost was considerably less than I had expected , and I read that dedicated “guides” would be there via video chat to help me along the way and process my experiences. So, after some more research, I signed up. What did I have to lose?
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I’m not alone. More and more depression sufferers who haven’t found adequate relief via conventional methods are turning to ketamine therapy, and treatment clinics are popping up across the country. To explain what exactly the drug does to your brain and its potential for treating mental illness, I turned to two experts in the field for their input.
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The APA says that whoever is providing ketamine treatment needs to be trained in how to address behavioral health problems, because ketamine can cause dissociative effects such as hallucinations. The organization also says its critical that clinics have caregivers qualified to make sure patients arent at risk for behavioral problems including experiencing suicidal thoughts before theyre sent home.
Anesthesiologists, in turn, argue that psychiatrists arent qualified to provide ketamine treatment on their own. Theyre not prepared the same way anesthesiologists are to deal with problems that could crop up during an infusion, such as an irregular heart rhythm or more serious cardiac issues.
Belnap noted that the safety information included in every box of ketamine says that the physician administering ketamine should be trained in using anesthetics and managing problems with a patients airway.
Im not saying psychiatrists cant , but they need to have someone in the room or in the clinic who knows ketamine because they dont, Belnap said.
One thing is clear: Collaboration is critical.
You dont treat an advanced disease with just an infusion and a see you next time, Cusin said. If replace your knee but dont do physical therapy, you dont walk again.
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What Else Should You Know About Ketamine
- A much lower dose of ketamine is given for depression compared with the dose necessary for anesthesia.
- Like opioids, ketamine has addictive properties. Its important to understand this when weighing risks and benefits. If you have a history of substance abuse such as alcohol or drugs its especially important for you and your doctor to consider whether ketamine is a good option for you.
- When IV ketamine works, people usually respond to it within one to three infusions. If a person has no response at all, further infusions are unlikely to help. Instead, its probably best to try other treatments for depression.
- People who experience some relief from depression within one to three ketamine treatments are probably likely to extend these positive effects if the treatment is repeated several more times. The subsequent sessions may help prolong the effects of ketamine, rather than achieving further dramatic relief of symptoms. There are no standard guidelines for this. Many studies offer eight treatments initially . After this, patient and doctor decide whether to taper or stop ketamine treatments or continue treatments at longer intervals.
Antidepressant Mechanisms Of Ketamine And Potential Biochemical Biomarkers
There has been suggestion that glutamatergic neurotransmission is dysregulated in MDD., This is supported by findings of elevated serum and plasma glutamate levels in patients, and reduction of plasma glutamate levels following treatment with selective serotonin reuptake inhibitors . Of interest, the severity of depressive symptoms was found to be correlated with plasma glutamate levels. Elevation of extracellular glutamate in MDD may, in part, be caused by loss of glial cells that are responsible for glutamate/glutamine cycling. A consequence of increased extrasynaptic glutamate levels may actually be downstream suppression of glutamatergic neurotransmission via activation of metabotropic glutamate receptor 2 autoreceptors.
However, ketamines mechanism of action is more complex than antagonism of NDMA receptors. This is supported by the finding that other NMDA receptor antagonists such as memantine, lanicemine and nitrous oxide do not exert a consistent antidepressant effect in RCTs. Furthermore, a meta-analysis of single-infusion non-ketamine NMDA receptor antagonists, including traxoprodil, lanicemine and rapastinel , showed smaller effect sizes in depressive symptom change in comparison with ketamine and non-superiority in remission compared with placebo for unipolar and bipolar depression. It is likely that ketamines mechanism involves additional downstream targets, given that it is metabolized rapidly but demonstrates longer-lasting antidepressant effects .
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What Exactly Does Ketamine Treatment Entail
First, patients should meet with a board-certified psychiatrist for a full consultation and evaluation. If treatment is deemed appropriate, each session lasts approximately two hours, notes Dr. Levine. This consists of:
- Meeting with the psychiatrist before starting that days session
- A 40-minute ketamine infusion
- About 45 minutes of recovery time
- A second meeting with the psychiatrist
Talk therapy along with ketamine is very important, says Levine. During the IV infusion, patients are awake, but can feel floaty, disconnected, and have a heightened perceptual experience . But as long as patients are well-prepared for the experience, they tend to tolerate it well. By the time they leave the office, theyre back to how they felt when they walked in, and hopefully theyll start to see the benefits in the hours to days after, he says.
Typically, theres an induction or acute phase of ketamine treatment in which patients undergo three sessions in the first week, two in the second week, and then begin tapering off. Well go to once weekly for the next three weeks, then wait two weeks for the next treatment, then wait three weeks, then at least a month, says Levine. If someone requires ongoing maintenance treatment, the average time between treatments is one month.
Who Is A Good Candidate For Ketamine Treatment
Dr. Yermus says that anyone dealing with depression or anxiety who is in good physical health and has an open mind is a candidate for treatment.
However, the government is a bit more exacting when it comes to prescribing the esketamine nasal spray. The FDA has only provided approval for the treatment of treatment-resistant major depression and major depressive episodes associated with serious suicidal ideation and/or behavior, says Dr. Sanacora.
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Ongoing Mood Cognitive Changes May Require Professional Help
Depression is not only hard to endure, it is also a risk factor for heart disease and dementia. “Depressive symptoms can occur in adults for many reasons. If you are experiencing mood or cognitive changes that last for more than a few weeks, it’s a good idea to bring this up with your doctor or consult a mental health specialist to help sort out possible causes,” says Dr. Nancy Donovan, an instructor in psychiatry at Harvard Medical School.The four most common types of depression are major depression, persistent depressive disorder, bipolar disorder, and seasonal affective disorder.
Major depression. The classic depression type, major depression is a state where a dark mood is all-consuming and one loses interest in activities, even ones that are usually pleasurable. Symptoms of this type of depression include trouble sleeping, changes in appetite or weight, loss of energy, and feeling worthless. Thoughts of death or suicide may occur. It is usually treated with psychotherapy and medication. For some people with severe depression that isn’t alleviated with psychotherapy or antidepressant medications, electroconvulsive therapy may be effective.
What Are The Risks Of Taking Ketamine
Dr. Sanacora points out that the long-term effects of taking ketamine for depression remain unknown. During research involving animals, ketamine was shown to cause some toxic effects on the brain as well as behavioral and cardiovascular side effects, he said. While some human studies have also shown evidence of behavioral and brain abnormalities linked to ketamine use, this has generally been in people who use the drug recreationally, he notes.
Also, ketamine known by its street names Special K, Vitamin K, Kit-Kat, and Super K has been used recreationally for decades, particularly in the 1980s. So there’s a possibility for addiction if dosing isn’t professionally monitored. As its Schedule III label indicates, ketamine has “a moderate to low potential for physical and psychological dependence,” per the DEA.
Personally, I don’t feel that I developed any kind of dependence on the ketamine, but I do feel drawn to the healing nature of the ketamine experience. My Mindbloom guide said that, after doing an initial round of, say, three months of treatments, many clients do a refresher course once a year afterward to keep reaping the benefits of therapy.
That’s likely what I intend to do, and I can only hope that for myself and others ketamine treatment becomes more widely accessible and affordable in the future.
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Brain Areas And Neuronal Circuitry Involved In Ketamines Effects
Depression is now acknowledged as a complex disorder characterized by the involvement of many brain areas, neuronal circuits , neurotransmitters and intracellular mechanisms. Although it was reductive to think that the alteration of a single area could be sufficient for the generation of such a complex disorder, the search for such an area has represented a challenge for many researchers, whose ultimate goal was to better understand the etiopathogenesis of depression and thus improve the chances of developing new effective antidepressants. Moreover, the identification of a such an area would have favored the development and characterization of animal models of depression to test antidepressant drugs by ascertaining the reversibility of the changes observed. Among the areas that have been associated with depression, the hippocampus and the prefrontal cortex certainly stand out, but recently the NAc has also been involved in consideration of its role in anhedonia , . In particular, the study of neurogenesis in the hippocampus has been used to correlate the effects of drugs on growth factors with their antidepressant potential . The effect of ketamine in the hippocampus, PFC, NAc, and lateral habenula will be discussed below in order to recognize changes that might be related to its antidepressant effect.
They May Deny The Problem
A depressed spouse may deny that they have any problem at all, Ben-David says.
âMany people with depression or mental health issues donât want to be âfixed.â They may just want to be heard. If in the process of listening to your partner, if you hear things that are too hurtful for you to handle, then turn to a professional for help,â he says. âYour spouse may not identify their behaviors as depression. If theyâre acting out with sex, drinking, drugs, or food, they may say, âI need this. It eases my stress.ââ
Encourage your spouse to get help and a diagnosis from a mental health professional. They can start with talk therapy and, if they need it, prescription medication, Barber says. Make an appointment with a psychologist, psychiatrist, counselor, or family doctor for a diagnosis, and begin therapy.
âPsychotherapy plus medication has shown to work better for depression than just medication. Medication without talking is not going to help,â says Barber, who adds that medication may be more appropriate to treat people with severe depression.
Some couples choose to have therapy together, especially if depression has led to sexual issues in the marriage, such as an affair, Ben-David says. Your depressed partner may prefer to do solo therapy. If theyâre struggling with addiction, they need to treat that before tackling their depression, he says.
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The Real Pros And Cons Of Ketamine Infusions
If you live with a major depressive disorder, you know just how challenging it can be to find a treatment plan that works well, continues to provide relief as time goes on, and doesnt come with unwanted side effects.
At TMS & Brain Health, we know that traditional antidepressants and regular therapy sessions arent always the best answer and theyre certainly not the only answer.
Thats why were committed to providing innovative, evidence-based solutions for people who are affected by treatment-resistant depression , including ketamine infusion therapy.
Lets explore how ketamine works, and the real pros and cons of this groundbreaking treatment for TRD, post-traumatic stress disorder , debilitating anxiety, suicidal ideation, and even chronic pain.
How Does Ketamine Work For Depression
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According to the World Health Organization, depression is a leading causing of disability worldwide, affecting 264 million people. Although many people are able to find relief with standard antidepressant medications, not everyone can. Depression treatment is never one-size-fits-all. One person may respond favorably to their first depression medication, while another may spend years trying a number of treatments with little to no relief. When someone is unable to find relief with two or more antidepressant medications from separate classes within four to six weeks after the target dose has been reached, their depression is characterized as treatment resistant depression . For those with TRD, one surprising new treatment has emerged that can relieve symptoms in a matter of hours: ketamine.
What is ketamine?
Since the late 1990s, ketamine has been used off-label in the treatment of depression, PTSD, and other mood disorders. Its rapid and often long-lasting results have caused many to consider it the most important breakthrough antidepressant treatment in decades. In early 2019, the FDA-approved a nasal spray containing a ketamine derivative for the treatment of . Ketamine IV therapy is still considered off-label, but it has proven effective in eliminating depression symptoms in people with treatment resistant depression.
How does ketamine work for depression?
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Stages Of General Anesthesia
Before they had machines to track your vital signs during general anesthesia, doctors came up with a monitoring system to keep patients safe. They divided the system into four stages:
- Stage 1: Induction. The earliest stage lasts from when you first take the medication until you go to sleep. Youâre calm but able to talk for a while. Your breathing is slow but regular, and you lose the ability to feel pain.
- Stage 2: Excitement or delirium. The second stage can be dangerous, so the anesthesiologist will want to get you through it as quickly as possible. You can have uncontrolled movements, fast heartbeat, and irregular breathing. You might vomit, which could make you choke or stop breathing.
- Stage 3: Surgical anesthesia. At this stage, surgery can take place. Your eyes stop moving, your muscles completely relax, and you may stop breathing without the help of machines. The anesthesiologist will keep you at this stage until the procedure is over.
- Stage 4: Overdose. If you get too much anesthesia, your brain will stop telling your heart and lungs to work. Itâs rare with modern technology, but it can be fatal.