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Kelsey Bates, APRN
One of my most absolute favorite parts about being a health care provider is learning about emerging treatments for various medical issues. The emerging treatment this blog post discusses is ketamine infusion therapy for depression.
In general, the medical world seems to focus more heavily on physical health versus mental health. If we could give both the physical and mental aspects of health the same focus, the population would be in a better place overall. Individuals living with chronic pain are likely to be depressed. The depression is only going to make the chronic pain worse, it’s a vicious cycle. Sometimes when reviewing a patient’s history I learn that they have only been treated for their chronic pain issue.
Shouldn’t we be treating the “whole patient?” If more health care providers were to not only focus on the patient’s chronic pain but their depression as well, I guarantee the patient would have a much better outcome. Mental health plays a HUGE role on our physical health. In fact, mental health can often times be harder to treat than physical health. In school and throughout our training we become well versed in the common SSRI’s, SNRI’s, TCA’s, MAOI’s and benzodiazepines to treat mental health disorders.
Often times patients have to try two or more different antidepressant or antianxiety medications to find what works best for them. Even when they do find one that works better than the other it still may not alleviate their symptoms to a desirable level. They may also suffer with side effects from the medication. These commonly Include low libido, having little to no emotion, fatigue, nausea, vomiting, headache, dry mouth, trouble sleeping, restlessness, etc.
When is Ketamine useful?
When a patient crosses the bridge of having tried different medications and therapy to help with their depressive symptoms but are still dealing with significant depressive symptoms, where can we go from there? An option would be ketamine infusion therapy.
Ketamine has been around for a long time and approved by the FDA for anesthetic purposes. Ketamine holds an off-label treatment for depression. In fact, at very low doses (subanesthetic), it can be very effective. Most studies are based on intravenous infusions but there are other routes such as oral, sublingual, intramuscular and a nasal spray form. What I find amazing about ketamine infusion treatments is how fast acting they are on depressive symptoms and even suicidal ideations. Studies have shown improvement of symptoms within one to twenty-four hours. The mainstream pharmaceutical options for depression can take weeks to have an effect.
Ketamine infusion therapy for depression is usually given as a series of six doses over two weeks. Not only have studies shown the rapid improvement in depressive symptoms and suicidal ideations but patients report an overall decrease in illness severity after the two weeks. More studies focusing on the longer-term effects of the treatmentare needed. Many patients have also reported continuous relief of their symptoms post ketamine infusions.
Not only are low dose ketamine infusions a safe treatment, it doesn’t come with the lasting side effects that many of the other antidepressant medications cause. Things to watch out for during an infusion would be elevated blood pressure, nausea, perceptual disturbances and dissociation. These side effect resolve quickly after the infusion is over.
How does Ketamine infusion therapy for depression work?
You may wonder, how does the ketamine work? As with many things in medicine, it’s not exactly clear how it works but science has shown ketamine targets the N-methyl D-aspartate receptors in the brain. Ketamine binds to the NMDA receptors in the brain thus increasing the neurotransmitter glutamate. Glutamate then turns on a amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors which release other molecules that help the neurons communicate better along new pathways. This in depth process positively affects mood and thought patterns.
It’s said that about 70-73% of patients have success with ketamine infusions. Considering how debilitating depression can be I’d say it is definitely a treatment worth looking into.
References
Mandal, S., Sinha, V. K., & Goyal, N. (2019). Efficacy of ketamine therapy in the treatment of
depression. Indian journal of psychiatry, 61(5), 480–485. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_484_18
Meisner, R. C. (2019, May 22). Ketamine for major depression: new tool, new questions. Harvard Health
Blog. https://www.health.harvard.edu/blog/ketamine-for-major-depression-new-tool-newquestions-2019052216673
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