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What Is Ketamine Treatment?

What Is Ketamine Treatment?

You may have heard about ketamine as a treatment for severe depression. You may have also heard about it as a street drug. In this article we will go over what ketamine is and how it shows promise in treating PTSD as well as severe depression that is not responding to other treatments.

What Is Ketamine?

Ketamine first started out in the 1960s as a medication for use in anesthetizing animals. In 1962, it was synthesized by the drug company Parke-Davis, which is now Pfizer. In 1970, the FDA approved its use in humans as an anesthetic.1,2

Ketamine as Medication

While most other anesthetics depress respiration and can lower blood pressure, ketamine can create sedation, pain relief, and a feeling of dissociation without also causing those side effects.1 This makes it an ideal medication for use on the battlefield to help transport wounded soldiers, or for pediatric use in emergency room treatments, and many other applications such as chronic pain management or use during cesarean sections.2 Ketamine is also sometimes used by emergency responders to calm an agitated patient whom they need to transport after a suicide attempt. Doctors started to notice that some of these severely depressed patients reported a dramatic improvement of their depression after receiving ketamine. This created the motivation to investigate the medication as a potential treatment for depression and suicidality.1

Illegal Uses of Ketamine

According to the DEA, ketamine is a Schedule III drug with potential for abuse and addiction.3 Due to the dissociative effects and feelings of euphoria of ketamine it has been used illegally as a recreational drug. Illegal use of ketamine carries many risks, such as becoming unconscious, a dangerous increase in blood pressure, and possible fatal outcomes if used in combination with alcohol.1

Chronic illegal use of ketamine may also lead to long-term illnesses, such as ulcers and chronic pain in the bladder, stomach pain, memory issues, and kidney problems.1Many medications can become a drug of abuse, and medical treatment with ketamine currently has safeguards in place to prevent this from occurring.

Ketamine Treatment for Depression

Ketamine has been found useful for treatment of debilitating or treatment-resistant depression, and also depression with suicidal thoughts or attempts.Prior to its approval for the treatment of depression by the FDA in 2019, physicians had been using ketamine this way as an “off-label” medication for years.3 “Off-label” use is very common. It is when a physician legally uses a medication to treat a condition other than what it is currently approved for. Almost 20% of prescriptions are written for “off-label” use.4

In the spring of 2019, the medication esketamine was approved by the FDA for treatment-resistant depression. Esketamine is a slightly different version of ketamine. Currently it comes in the form of a nasal spray that is administered in the doctor’s office under close supervision. The patient may not take the medication home.3 Ketamine is also currently being administered IV (ketamine infusion therapy) or by injection in a medical setting as treatment for relief from symptoms of depression. This is currently an off-label use, but there are many clinics across the country that offer the treatment.¹

Research has shown that ketamine targets different brain actions than other antidepressant medications. It is believed that ketamine blocks a receptor for a brain chemical called NMDA.3 Studies of esketamine has been shown it to have a significant effect on severity of depression in as little as two days after treatment.¹

Ketamine Treatment for PTSD

Post-traumatic stress disorder (PTSD) is an ongoing condition caused by the experience of a traumatic life event. PTSD creates a state of high vigilance and the patient suffering with it experiences flashback, nightmares, and intrusive thoughts.5

There has been research done on the effects of ketamine treatment for PTSD that is showing some promise with symptoms improving rapidly, though the results seem to only last a couple weeks.5 There are also some physicians using ketamine to treat PTSD and this is currently also an off-label use.

Ketamine Treatment with MD Supervision

Ketamine treatment must only be done under close supervision and with a medical professional. The nasal spray form is to be used only in a doctor’s office and will not be taken home.6 Since side effects of ketamine and esketamine can produce feelings of detachment from reality, changes in visual and sensory processing, as well as symptoms similar to drunkenness, close supervision is needed by a medical professional during treatment.¹

People Who Should Not Use Ketamine

There is some concern about people with a history of addictions using this treatment. Due to its potential for abuse there should be a careful screening process in place before treatment begins. There is also concern about people with anxiety using ketamine treatment as some research has shown that ketamine can increase anxiety. There is some research that has shown that IV ketamine treatment at lower doses is an effective treatment for patients with anxiety and depression.7 People with chronic or poorly controlled high blood pressure or pre-existing circulation system disorders may be at a higher risk of cardiovascular issues from ketamine treatment. They should be carefully assessed by an MD before starting treatment.6

Integrating Ketamine Treatment

Ketamine treatment can create rapid and effective change in levels of depression, but it’s not a magic bullet. Many practitioners recommend that patients continue with talk therapy and other treatments to improve their mental health and wellbeing.¹Some patients have reported that after treatment with ketamine they found they made much more progress in talk therapy.¹ Integrating ketamine treatment with other treatments may promote the highest amount of change and healing.Here at Balance Treatment Center we offer a wide variety of modalities to help improve the quality of life and encourage emotional, personal, and psychological growth.

Sources:

  1. https://www.webmd.com/depression/features/what-does-ketamine-do-your-brain
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4933765/
  3. https://www.verywellmind.com/ketamine-to-treat-depression-5114938
  4. https://www.ahrq.gov/patients-consumers/patient-involvement/off-label-drug-usage.html
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6457782/
  6. https://www.fda.gov/news-events/press-announcements/fda-approves-new-nasal-spray-medication-treatment-resistant-depression-available-only-certified
  7. https://advances.massgeneral.org/neuro/journal.aspx?id=1233