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Ketamine Infusion Therapy

Ketamine is an FDA-approved anesthetic. But these days, ketamine is receiving a lot of positive attention due to being used “off-label” to treat treatment-resistant depression (TRD). Whenever a drug is used “off-label” it means that it is being used in a manner that doesn’t have FDA approval. Ketamine infusion therapy is the administration of a single infusion or a series of ketamine injections. This type of therapy helps with the management of several psychiatric disorders such as:

While ketamine isn’t considered a front-line therapy for chronic pain, depression, or any other disorder, it can be used to treat severe cases that haven’t responded to traditional medications or therapies.

What is Ketamine?

Ketamine is a widely used FDA-approved anesthetic that’s been used for more than 50 years. It’s also a medication with quick-acting antidepressant properties that have been studied by mental health experts for over two decades. Also known on the street as “Special K,” ketamine has been abused in the past as a recreational drug because of its hallucinogenic and tranquilizing effects.

What are the Advantages of Ketamine Infusion?

Worldwide, depression is the principal cause of disability and the main mental health disorder that brings about suicidal tendencies. About two out of three people with major depression eventually achieve lasting remission of their symptoms with traditional antidepressants. The remaining one does not change.

For those people with treatment-resistant depression, anxiety, persistent PTSD, and chronic pain, ketamine infusion can provide several advantages including:

Being Fast-Acting

Ketamine infusions work quickly to ease symptoms of depression–frequently within hours. Although researchers are still trying to identify the process behind this dynamic effect, they do know that it stimulates a rapid increase in glutamate. 

Glutamate is the main neurotransmitter, a chemical messenger that carries, boosts, and balances signals between nerve cells. This encourages the growth of synapses in your brain. 

Synapses connect nerve cells in the brain to nerve cells in the rest of the body. Ketamine helps strengthen and restore important brain connections and pathways in the areas of the brain that are most impaired by depression. The new connections help encourage beneficial changes in the function of the brain’s circuitry.

High Success Rate

Research shows that ketamine infusion has a high rate of success in treating TRD. Several studies indicated that over half of people with TRD were able to obtain significant relief of their symptoms after a single infusion. Many more found relief after two or three infusions. 

An excellent rate of effectiveness is an important part of what makes ketamine infusion therapy so beneficial for individuals who haven’t been able to get lasting relief through common medical solutions.

Lasting Remission

Ketamine infusion therapy isn’t a treatment that cures depression in a single session. However, it’s also not like traditional antidepressants that have to be taken daily for years, or as long as they are effective. Rather, ketamine infusions stimulate beneficial changes in the brain that bring lasting symptom relief throughout a single treatment cycle.

On average, the acute phase of ketamine infusion therapy calls for a series of six infusions spread out over the course of two or three weeks. This beginning treatment is followed up by a long-term maintenance phase that includes booster shots as needed.

PTSD Relief

Ketamine may give relief from PTSD that many people, particularly veterans, suffer with. PTSD is a mental health disorder that people may develop after experiencing a trauma such as combat. At the Neurosciences Medical Clinic in Miami, where 35% of their clients are military veterans who need treatment for PTSD, ketamine therapy is giving them hope that other kinds of treatment can’t provide.

Pain Management

In addition to being included in the treatment of psychiatric disorders, ketamine is also being used for post-operative and chronic pain management. Intravenous (IV) ketamine infusion therapy has been developed as a treatment for a number of conditions.

Ketamine Infusion Disadvantages

Of course, no treatment is perfect. And even though it can offer major benefits in the treatment of persistent depression, the disadvantages of ketamine have to do with its dissociative (feeling detached from reality) effects and its potential for addiction. 

Major Drawbacks

Until the long-term effects of ketamine infusion therapy are studied more thoroughly, caution in using it is advised by some medical professionals. Some of the major issues with ketamine therapy are:

  • The helpful effects tend to wear off after 7 to 10 days so infusions need to be done on a regular basis
  • Studies have indicated that it might be toxic to brain cells
  • At higher doses, it may cause bladder damage
  • Psychotic-like symptoms during treatment

Side Effects

All drugs have side effects. But when a person is suicidal or seriously depressed, the potential benefits may outweigh the possible side effects. While ketamine infusion therapy is used in doses that are below the level for anesthetizing, it can still cause temporary side effects that include the following:

  • Mild hallucinations
  • Sensation of floating
  • Blurry vision
  • Dizziness
  • High blood pressure
  • Nausea and vomiting

Because of these side effects, ketamine infusion must be:

  • Only approved for use after a complete evaluation
  • Administered in a ketamine-certified clinical setting
  • Administered and supervised by an experienced provider

Transportation

The possibility of immediate side effects from ketamine infusion therapy means that you need to arrange for someone to drive you to and from the treatment session. Although the mild dissociative side effects of ketamine infusion therapy diminish quickly, it can leave you feeling groggy and tired until you’ve gotten a good night’s rest.

Not for Everyone

Ketamine isn’t the solution for everyone with TRD. Due to its potentially addictive properties, it might not be a good choice for people who have a history of substance abuse or a diagnosed addictive disorder.

Why Ketamine is Important for Treating Depression

The importance of ketamine as a form of depression treatment is that it can:

  • quickly reduce suicidality (life-threatening behaviors and thoughts)
  • relieve other serious symptoms of depression
  • be effective in treating anxiety combined with depression

In addition, other treatments for depression and suicidality usually take weeks or even months to take effect, as noted earlier, and many people need to try several different methods and medications to achieve relief. This is true for:

  • Psychotherapy (talk therapy)
  • Antidepressant medications
  • TMS (transcranial magnetic stimulation
  • ECT (electroconvulsive therapy)

Currently, ECT is the most effective treatment for people that suffer from major depression that don’t respond to other therapy approaches.

Two Types of Ketamine Treatment

There are two types of ketamine used to treat major depression that hasn’t responded to two or more treatments (TRD). The two types are:

  • Esketamine (Spravato): It is given as a nasal spray and is FDA-approved. Patients continue to take their antidepressant medications and receive the esketamine at their doctor’s office or in a clinic where they can be watched for 2 hours after the dose. To treat TRD, patients typically get the nasal spray twice a week for 1 to 4 weeks and then once a week for up to 9 weeks. Then once a week after that.
  • Racemic ketamine: Usually given as an IV into the bloodstream (infusion). Is what’s FDA-approved as an anesthetic and used off-label for depression. You can only get it by IV or shot in a doctor’s office. Patients usually start with two infusions a week, then down to one infusion per week. Eventually, most people go to one infusion every 2 to 4 weeks. Most research stops the treatment at 6 weeks. There hasn’t been any research to show that more than 6 weeks in a row provide ketamine therapy more benefits, but people do go back for boosters if symptoms return.

These two types of ketamine have different effects on the receptors in the brain. The method that the drug ketamine is administered and the type will determine the drug’s effectiveness and side effects. Most of the research so far has been on ketamine infusions.

John Krystal, MD, chief of psychiatry at Yale-New Haven Hospital and Yale School of Medicine encourages patients to continue with their psychotherapy after receiving ketamine treatment. Likewise, physicians who administer ketamine infusions usually recommend that patients continue with their antidepressant medication plan also. Also, nasal spray is only approved with oral antidepressant medication.

Where Did Ketamine Come From?

The story of ketamine began in 1956 with the synthesis of the drug, phencyclidine (PCP). PCP was discovered to be a great anesthetic for monkeys and was used on humans after many testings on animals. However, the side effects observed in some patients were disturbing. 

Instead of waking up peacefully from anesthesia, some were experiencing acute delirium that lasted for hours after their operation was over. Patients described feeling deprived of their senses and the loss of sensations in their limbs. Subsequent studies showed that phencyclidine caused a sensory deprivation syndrome.

In an effort to find a short-acting alternative, Dr. Calvin Lee Stevens synthesized phencyclidine derivatives. The compounds he synthesized were tested on animals and one was found to be successful as a short-acting anesthetic. After being selected for human testing, it was titled CI-581 and eventually came to be named ketamine for the ketone and amine group in its chemical makeup.

Treatment for Depression at Florida Center for Recovery

Are you struggling with depression? Or are you using substances to dull the feelings? It is a common occurrence. You don’t have to suffer from either one. Florida Center for Recovery has specialized programs for individuals who have co-occurring conditions of addiction and depression. 

Don’t let these debilitating conditions rob you of your life and happiness. It is possible to live a fulfilling life and reach your goals, but you have to get started. Take that first step and contact us now.  You have everything to gain.

References:

www.psycom.net/ketamine-depression

www.psychiatry.uams.edu/clinical-care/in

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