Ketamine, a dissociative agent approved by the FDA as an anesthetic, has been gaining popularity as a fast, effective, off-label treatment for depression. Research has found ketamine to be especially helpful in cases of treatment-resistant depression that have not responded to other medications, and for patients suffering from severe symptoms, including suicidality, who need rapid relief. Unlike conventional antidepressants, which often take up to 6 weeks to improve symptoms, ketamine can have an effect after just one or two infusions.
Major depression is the leading cause of disability in the world, according to the World Health Organization, and roughly 6 to 7% of Americans will have a depressive episode in any given year. While 60 to 70% of people with depression respond to traditional antidepressants, typically a selective serotonin reuptake inhibitor (SSRI), these medications are not effective for 30% of patients. Clinicians have long searched for effective alternatives for these individuals, who are often in acute distress.
"Mood disorders are very painful," writes William Dodson, MD, in the ADDitude article "The ADHD-Depression Link". "A study done in the mid-1970s at the National Cancer Institute asked people living with end-stage cancer and who had previously had a depressive episode which one was more painful; 98% said that the depression was more painful than terminal cancer."
Once known best as the club drug Special K, ketamine has emerged as a strong treatment option for depression. "Ketamine affects glutamate and GABA -- excitatory and inhibitory neurotransmitters of the brain. It promotes synaptic connections within the brain for learning and memory, but it can also block other receptors, leading to rapid antidepressant action," explains Roberto Olivardia, PhD, in the ADDitude article "Treatment for Depression and ADHD: Treating Comorbid Mood Disorders Safely." "Studies show that 60% or more of patients find relief from depressive symptoms with these infusions, and relief can be relatively short-acting, within 1 to 3 weeks."
Though ketamine clinics administer the medication in different ways, an infusion generally fits the following description:
- Lasts 40 minutes
- Dosage depends on weight
- Patient is fully awake
- May experience odd perceptions and disassociation
- A string of six sessions is typical
- Often not covered by insurance
Side effects tend to be mild and subside quickly. They include:
- Nausea
- Drowsiness
- Feeling "strange"
"Ketamine can actually induce neurogeneration, or creation of nerve cells in the brain, particularly in the hippocampus, which is a part of your brain responsible for memory," Olivardia explains in the ADDitude webinar "The ADHD-Depression Link in Adults: Symptoms & Treatments." "While the FDA has only approved ketamine as an anesthetic and has not approved it as an antidepressant, it is definitely being used with a lot of good results and very promising research."
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