Ketamine, one of the safest and most widely used medications in the world, now treats depression in Vermont.
Ketamine not only alleviates physical pain for patients, but it also has an effect on psychological pains. While doctors explored the use of low-dose ketamine in patients diagnosed with schizophrenia, it was discovered that it had significant positive effects on patients who were experiencing depression and anxiety.
The use of Ketamine as an effective means of addressing treatment-resistant depression is growing in popularity. It’s really not too surprising, Ketamine has been around for a long time, it just hadn’t been properly studied or explored as a treatment for depression until about 20 years ago.
In 1962, Ketamine was synthesized (from phencyclidine derivatives) to be used as an anesthetic. Up until then, producing a state of general anesthesia could be done in various ways (opium, nitrous oxide, chloroform, herbal remedies, etc) but they all had their drawbacks. Some could prevent a patient from feeling any pain during a procedure, but it might suppress their breathing so heavily that they’d die. Others might not suppress breathing too much, but also would not suppress the sensation of pain enough.
Over the centuries that anesthesia has been available, it has evolved and improved. The primary concern of anesthetic use is keeping the patients’ airway open, breath flowing, and the heart pumping.
Unlike other anesthetics, ketamine doesn’t slow breathing or heart rate, so patients don’t need to be on a ventilator to receive it. This was a significant breakthrough in the world of sedatives.
While it was widely accepted that Ketamine alleviated physical pain for patients and was a safe sedative, it was eventually noted that Ketamine also had an effect on psychological pains. While doctors explored the use of low-dose ketamine in patients diagnosed with schizophrenia, it was discovered that it had significant positive effects on patients who were experiencing depression and anxiety.
Epidemic Level Depression
Neuropsychiatric diseases are estimated to put the heaviest burden on society. In his New York Times bestseller, Lost Connections, author Johann Hari explains that “depression and anxiety are now at epidemic levels.” This staggering reality is well-known to many people. Depression is the leading cause of disability in the world and nearly 10% of the US population suffers with a depressive illness each year. Some recover, some worsen, and many are left struggling in between.
Up to half of all people with depression and anxiety disorders are not adequately treated by conventional therapies, or cannot tolerate the side effects of antidepressant medications and so many continue to suffer from what is now called, treatment-resistant depression. There is a great need for better mental health treatment options.
The way science has understood depression and anxiety disorders has been relatively limited over the years, and treatment options have followed suit. Author Johann Hari identifies nine different causes for depression beyond the old “chemical imbalance” theory that has dominated the medical world for so long. What he brings to light in Lost Connections is how much influence the way that we live in this modern-day impacts our mental health.
It may be easy to point fingers at science for not doing more, for not having a better understanding of how to treat depression and anxiety at this point in the game, but that doesn’t solve the problem that needs to be solved. What’s really needed, in addition to a more thorough understanding about the various causes of depression, are solutions that really help people experience a turnaround.
Treating Depression
There haven't been any new classes of drugs developed to treat depression in decades.
Today’s drugs that are used to treat depression and anxiety disorders are drugs that increase serotonin levels (serotonin is a neurotransmitter believed to influence our sense of well-being and happiness) and they rank high among the most prescribed psychiatric medicines today. These drugs are called SSRIs and were once considered revolutionary.
SSRIs, according to many unhappy patients and frustrated physicians, now seem more like just another unremarkable tool in the psychiatric armory more than they are a powerful or effective therapy and SSRI medications are not highly successful in cases of mild depression. They show a treatment response rate of about 50%...with remission rates at about 40%. Less than a third of depression patients respond to a drug within 14 weeks, according to the 2006 STAR*D trial, the largest clinical test of antidepressants. They fail to help a lot of patients whose depression stems from something other than a “brain-chemistry imbalance”.
And then there’s the bothersome side effects:
Insomnia
May increase the risk of suicide in some patients
Dry Mouth
Diminishes libido
Nausea
Adds to stubborn weight gain
Creates extreme fatigue
and they often take several weeks to begin to have an effect, one which may only be short-lived.
Our current mainstream treatments work so poorly in part because we don’t really understand what they do. Serotonin was first found, in 1935, within the gut. It’s a neurotransmitter…a chemical messenger that sends direct messages to the brain…and it quickly became THE poster child target for current antidepressant drugs. Research on new drugs or other therapeutic options for depression has mostly stagnated for years, leaving a huge unmet need for this pandemic-level problem.
In Comes Ketamine Therapy
Around the year 2000, when looking for a more humanistic approach to treating depression, something that had less emphasis on a medicalized perspective, Phil Wolfson, along with his partner Julane Andries, a therapist, pioneered what he called ketamine-assisted psychotherapy.
One of the first things the couple recognized was that Ketamine wasn’t just an antidepressant, but also a powerful vehicle for transpersonal exploration and understanding….something they knew from folk-healing traditions as well as traditional psychiatry played a significant role in long-term improvement for mental health.
It is the transpersonal dissociative property of ketamine that has made it a popular recreational drug known as “special-K”. When we dissociate from our bodies and our minds, we’re able to gain a new perspective on chronic patterns of looking at problems, habits, and personal issues. It’s not that they go away, but people are able to experience these things from an observer's perspective…and therefore make some traction in therapy and recovery.
Using ketamine to successfully treat depression and anxiety disorders that have already been diagnosed as “treatment-resistant” might just be the biggest development in mental health therapy in the last 50 years.
While research on ketamine as an antidepressant is still only beginning, scientific studies done at the National Institute of Mental Health and academic centers across the globe have found that about ⅔ of people have a successful response to ketamine infusions for treatment-resistant depression and, in many cases, experience significant and lasting improvements in mood and overall well-being within hours to days.
The excitement over ketamine therapy is spreading quickly. To have something to offer patients who have not previously responded to anything is really incredible, especially for patients who are at risk of suicide. It is also helping scientists to have new insights to the biology of depression and anxiety. Ketamine targets the glutamate neurotransmitter system (instead of the serotonin neurotransmitter system) and this awareness is helping to shape a new era of treatment options and support for a lot of people.
It is believed that ketamine works with the brain’s innate malleability and influences the growth of synapse areas in the brain that have atrophied, namely the hippocampus and prefrontal cortex. It may also help to build new synapses between neurons. In fact, it’s believed that ketamine manipulates many receptors in the brain, but scientists have yet to explore the full depths of what’s possible and how it all works. Still, it is being used to treat the following conditions with promising success rates:
Is there a downside to Ketamine?
Treating depression with ketamine is an "off-label" use of the drug. Meaning, it is not something that the FDA has approved it for, so it’s not covered by health insurance policies, even when it is recommended by a doctor. However, many insurance companies will cover the cost of the office visit, and that may reduce the price of the Ketamine Therapy session. The average fee varies nationally, but you'll probably pay about $300 - $500 a session. For most people, it's suggested they attend a session once every 3-14 days until they've completed 6-12 sessions. After that initial treatment period, moving on to booster sessions, spaced out a few times a year, is common. Still, everyone responds differently and therapeutic protocols are created per the individual.
Another area that medical professionals are watching out for is that Ketamine can have addictive potential, and the last thing anyone wants to see is another version of the opioid epidemic, something that begins as a way to help people in pain but creates another problem of its own. Currently, Ketamine therapy is recommended alongside psychiatric talk therapy and only administered in medical clinics under supervision.
If you’re averse to IV’s and needles, there are other types of approved means to administer Ketamine, like nasal spray and lozenges. This is a promising pathway for supporting people experiencing treatment-resistant depression and anxiety and there are ways to make it work for your individual needs. Talk with your healthcare providers today to learn more about exploring Ketamine Therapy and how to get started with treatment.
