Developed in the 1960s, Ketamine is an anesthetic drug that blocks pains, originally used on soldiers in during Vietnam, and often used as an animal tranquilizer. Since then it has often been used an an illicit “party drug,” nicknamed “Special K”, for the “out of body” sensation it provides.
In 2000, research began to investigate its usage to treat depression. It’s been found to improve mood more quickly than traditional antidepressants, and can help relieve treatment resistant depression.
With 16 million Americans suffering from depression each year, a third of which do not respond to first-line treatments, alternative therapies are in demand. Ketamine IV treatment is proving to be a promising option for those not seeing results from traditional methods. With such quick and dramatic results, the FDA granted breakthrough therapy status for two ketamine based drugs, and fast tracked them to the market. Gerard Sanacora, MD, PhD, director of the Depression Research Program at Yale University, claims it’s potentially the most exciting development for treating mood disorders in his lifetime, but acknowledges there is still much to learn about how it works, and the best ways to administer it.
Currently Ketamine is approved by the FDA to treat suicidal thoughts, PTSD, depression and other mood disorders, as well as nerve-related pain. Treatment is typically only available at select clinics, though it’s also utilized in clinical trials.
Typically Ketamine is administered via an IV because it’s the quickest way for the medicine to reach the brain. Most treatment plans begin with 6 doses over one to two weeks, followed up maintenance doses every three to five weeks. Treatment is typically given for at least a year to result in long term results.
Unlike traditional antidepressants which can take weeks to begin to see effects, Ketamine begins to work within a few hours. This is especially crucial to individuals experiencing suicidal thoughts.
The exact way in which ketamine works to treat depression is still unclear, but there are strong theories developed. It’s believed that Ketamine actually alters they way the brain cells, or neurons, communicate with one another, unlike traditional antidepressants, which just adjust the balance of chemicals like serotonin and dopamine. If you look at the brain like a computer, Ketamine is working to fix the “hardware”, while antidepressants fix the “software.”
They do know that ketamine blocks the NMDA as well as opioid receptors in the brain, which are believed to play a role in depression and pain.
Patients report a lightening of their moods, lifting of dread, and less anxiety, rather suddenly. That said, it’s important not to tout the drug a quick fix miracle cure. The initial effect typically only last a few days, then additional treatment is needed. It’s also recommended to pair the treatment with cognitive therapy for optimal benefits.
For about an hour after treatment, patients may experience an “out of body” experience, which can be jarring, though many find it euphoric. It also causes a spike in in heart rate and blood pressure, though typically not more than one experience after general physical exertion, for individuals with heart issues this could be riskier. The long term impacts are still being studied. There has been some connection to Ketamine use and an impact on memory or cognitive function, but not at the dose typically given for depression. There is also the concern for potential abuse, which has not been fully explored yet in research.
The root of it’s lack of approval is in funding. So far trials have been relatively small, and to receive fully FDA approval there must be more wide ranged research done. That research will cost millions of dollars. Because ketamine is a generic drug, pharmaceutical companies can’t patent the drug to make their money back from investing in research. However some companies are beginning to develop other drugs based on ketamine, including a nasal spray, and another that acts on NMDA receptors.
While there is still much to discover, Ketamine IVs show great promise as an alternative treatment for depression and mood disorders. If you are seeking treatment be sure the clinic does the following: