There has been a lot in the news regarding Ketamine and its use and potential benefits in a variety of mood disorders,- including major depressive disorders. This includes a 2017 article in the American Journal of Psychiatry suggesting Ketamine may be effective in treating suicidality, and subsequently hundreds of articles both in the lay press and medical press have emerged.
Because Ketamine was first introduced as an anesthetic in the 1970s, it can no longer be patented. Therefore, pharmaceutical companies have no incentive to undertake intense and costly clinical trials to provide new indications.
It has also been historically used as a ‘party drug’ in an illegal fashion when used NOT as appropriately indicated. This has led important governing bodies like the American Society of Regional Anesthesia (ASRA) and American Psychiatry Association (APA) to create consensus opinion and guidelines.
The consensus statement by the APA in the American Journal of Psychiatry found seven placebo-controlled, double-blinded randomized clinical studies on Ketamine for the treatment of depression. Additional studies have examined Ketamine in addition to electroconvulsive therapy. At least one study has examined Ketamine as a treatment agent for obsessive-compulsive disorder.
Dr. Gerard Sancora, MD, Ph.D., one of the lead authors of the consensus statement has said, ‘There is evidence that in a significant proportion of patients who have not received satisfactory benefit from standard antidepressant therapy, ketamine can offer very rapid antidepressant effects, possibly within 4 hours..’
A meta-analysis published in the American Journal of Psychiatry in October 2017 found that ketamine infusions can significantly reduce suicidal thoughts in depressed patients, in as little as one day, with benefits lasting at least one week.
The consensus statement provides an overview and expert clinical opinion on six critical issues associated with ketamine treatment for mood disorders:
- Treatment Setting: A clinical setting with appropriately trained providers and safe monitoring methods and emergency management protocols.
- Patient Selection: Before initiating treatment, patients should go through a pre-treatment evaluation process including medical and psychiatric symptoms.
- Medication Delivery: Recommendations to follow the appropriate dosing guidelines per recent publications.
- Repeat Infusions: Long-term repeated administration of ketamine using a two- or three-week course of ketamine delivered two or three times per week. Followed by a taper period and/or continued treatment based on patients response.
- Safety Measures and Continued Treatment: Assessment of cognitive function, urinary discomfort and substance abuse should be evaluated with long term treatment.
- Clinician Experience and Training: Ensure the appropriately trained experts are providing care.
Ketamine and Suicidal Ideation
Most potentially helpful medications take days to weeks to work during an acute suicidal crisis. Ketamine has shown a rapid therapeutic effect. Let’s review a study performed by Dr. Murrough, an assistant professor of Psychiatry and Neuroscience at Mt. Sinai Medical Center in New York.
This was a randomized clinical trial in which the treating clinicians did NOT know if they were providing patients with ketamine or midazolam (a calming sedative). This study included 24 patients both as inpatients and outpatients with a range of mood disorders including suicidal ideations.
Results: Both groups experienced a reduction of Suicidal Ideations after treatment. At the 48 hour mark (after treatment), those patients receiving Ketamine treatment showed significantly lower suicidal ideations than those receiving other treatment.
This study was one of the first demonstrations showing rapid therapeutic effects of ketamine as an intervention for those with increased suicidal ideation and suicidal behavior. These results are promising regarding the rapid benefits of ketamine in the appropriate circumstances.
History of Ketamine
Ketamine’s benefits extend beyond use as an anesthetic, though — in some cases it can serve as a balm for the mind as well. A 2008 analysis found that burn victims who were given ketamine were less likely to develop symptoms of post-traumatic stress disorder, even if their injuries were more severe.
Those findings have been replicated, such as a 2014 clinical trial of 41 patients, who saw their PTSD symptoms diminish within 24 hours, an effect that lasted for two weeks.
But it wasn’t until the 1990s that what could turn out to be ketamine’s most important function was discovered. A team from Yale University School of Medicine was examining the role of glutamate, a common neurotransmitter, in depression, and discovered something remarkable: ketamine could rapidly relieve depression symptoms.
“To our surprise, the patients started saying, they were better in a few hours,” Dennis Charney, one of the researchers, told Bloomberg. This rapid relief was unheard of in psychiatry.
Glutamate is associated with neural plasticity, our brain’s ability to adapt and change at the level of the neuron. Ketamine blocks certain glutamate receptors, but not others and the end effect could be to promote the growth of new neurons while protecting old ones. This could explain how ketamine can help reset the brain, though the theory hasn’t yet been definitively proven.
The prescription meds currently on the market for depression have some major drawbacks. Drugs like Prozac or Wellbutrin can take a few weeks or months to kick in while worsening symptoms in the short term — not a good combination, especially for someone who is extremely depressed, or even suicidal.
It took around a decade for mainstream science to take notice of these early ketamine-depression studies. But once it did, ketamine clinics have opened across North America, offering fast relief for depression, anxiety and other mental illnesses. Patients are given an infusion — an IV drip that lasts about an hour — and many people, have seen rapid relief of their symptoms.
Why StrIVeMD Wellness and Ketamine Clinics?
What separates services at StrIVeMD Wellness and Ketamine Clinics in comparison to many other clinics around the country that are offering mood-based disorder management?
We strive and surpass recommendations from consensus statements developed by national experts from the American Psychiatry Associate, American Society of Regional Anesthesia, American Pain Society, and others. Doses of ketamine that are used to enhance, alter and improve mood disorders (Major Depressive Disorder, Bipolar, Obsessive Compulsive Disorder, PTSD, Anxiety and others) are considered ‘sub-anesthetic.’
Ketamine has been used as a medication to induce anesthesia for patients for the past 50 years. As is such, our team of board-certified, academic Anesthesiologists, Neurologists, Pain Physicians and Psychologists provide the most comprehensive treatment team available to our patients.