For depression that has not responded to oral antidepressants, there is an amazing new breakthrough treatment: intravenous ketamine. One of the most remarkable aspects of IV ketamine is that it can relieve depression in hours or days, as opposed to oral medication that can take up to two months to work.
Depression is a serious problem in the United States and one of the leading causes of disability. Currently, 17 million Americans suffer from depression. More than six million are unresponsive to oral antidepressants and have what is called treatment resistant depression (TRD). Statistics have shown a 30% increase in suicide rates from 2000 to 2016. Nearly 45,000 Americans died by suicide in 2016, making it the second leading cause of death that year for people ages 10 to 34. The recent suicides of celebrities such as fashion designer Kate Spade, Chef Anthony Bourdain, and comedian/actor Robin Williams, have drawn much more national attention to the diagnosis of depression.
Approved by the Food and Drug Administration as an intravenous anesthetic agent, ketamine has been in use worldwide since the 1970s. Approximately ten years ago, it was discovered that low dosages of ketamine can provide relief from depression, even for people who have failed to respond to oral antidepressants. How important is this discovery? Thomas Insell, MD, former director of the National Institute of Mental Health, stated, “Recent data suggest that ketamine, given intravenously, might be the most important breakthrough in anti-depressant treatment in decades.”
Ketamine is not considered first-line depression treatment – the majority of people have good results with oral antidepressants. There are several different categories of oral antidepressants and many different brand names. It can take up to eight weeks of treatment to determine if any given medication is successful. If one is not effective, then another medication can be prescribed for another eight weeks. Approximately one third of people never achieve effective relief of depression with oral antidepressants and are diagnosed with TRD. Treatment with intravenous ketamine is indicated for these people, and is effective for at least 70 percent of them.
One of the most remarkable aspects of IV ketamine is that it can relieve depression in hours or days, as opposed to oral medication that can take up to two months to work.
For treatment of depression, a low dose of ketamine is given as an intravenous infusion. Typically, a dosage of 0.5mg per kilogram of body weight is administered over 40 minutes. Initial treatment typically consists of six infusions over the course of 1.5-3 weeks. After six treatments, it will be evident whether the patient is a responder (70%) or a non-responder (30%). To maintain relief of depression, 1-2 infusions may be necessary weeks or months later, and periodically, thereafter.
Ketamine has been FDA-approved for use as an anesthetic agent since the 1970s. It was used during the Vietnam War as an analgesic/anesthetic for battlefield trauma. It is still used throughout the world, including the United States. However, using ketamine to treat depression is considered an “off-label” use, which means it is a treatment that the FDA did not originally approve. Therefore, it is not covered by health insurance, so people need to pay for the treatment out-of-pocket.
Ketamine works by a completely different mechanism than that of oral anti-depressants. It works on brain cells in the prefrontal cortex and the hippocampus. Brain cells communicate with each other via synapses, structures that somewhat resemble branches extending from the trunk of a tree. There are gaps between synapses of brain cells known as a synaptic cleft. Chemicals called neurotransmitters are released from one cell, cross the synaptic cleft, and activate receptors in the next cell. In animal models of depression, loss of synapses and loss of brain volume has been shown in the prefrontal cortex and hippocampus. Ketamine is an NMDA receptor antagonist – it works quickly, increasing the release of glutamate, one of the neurotransmitters. Ketamine produces an increase in brain derived neurotrophic factor (BDNF). Through a process called synaptogenesis, BDNF restores synapses. In animal depression models, ketamine has been shown to restore synapses and restore loss of brain volume in the pre-frontal cortex and hippocampus.
If you or a loved one suffer from depression and have not responded adequately to oral antidepressants, IV ketamine may prove to be an effective treatment. More information can be found at great website – KetamineAdvocacyNetwork.org, which was originated and is maintained by ketamine treatment patients.
