Ketamine has emerged in recent years as a powerful aid in the treatment of depression.1 Though a popular recreational drug commonly abused across the U.K., ketamine was first introduced as anaesthetic agent in the 1960s2, and is still used as such today. In this blog, we will explore how ketamine is being used as a powerful antidepressant, and its potential for aiding recovery from anxiety-related and substance use disorders.

Ketamine for Depression

Depression is one of the most common mental illnesses worldwide.3 Depending on the severity of depression, which can range from mild to severe, depression can be managed with therapy and medication can be prescribed for symptom management. However, despite great efforts to treat and prevent depression, it is still widespread. According to the World Health Organisation, approximately 264 million people suffer from depression globally.4

For those who do not respond well to other forms of treatment and are experiencing suicidal ideation, ketamine may be an effective solution.5 Research is being carried out to investigate the efficacy of ketamine in treating depression6, though it is still in its early days. Reports on its efficacy tell us that ketamine may have a significant effect on the reduction of severity of a depressed client’s suicidal ideation.

While antidepressant medications typically take a number of weeks for their effects to begin, ketamine’s effects on depression can be observed within hours of administration.7 Ketamine’s antidepressant effects tend to appear as soon as the substance leaves the body, claims chief of psychiatry at Yale-New Haven Hospital John Krystal, MD.8

“Recent data suggest that ketamine might be the most significant breakthrough in antidepressant treatment in years,” says Dr. Farrukh Alam, MD, senior psychiatrist at Addcounsel.

Ketamine’s Effect on the Brain

Antidepressants focus mainly on the brain’s ability to release and reuptake brain chemicals involved in motivation and mood regulation, such as dopamine and serotonin.9

Ketamine, on the other hand, focuses primarily on the reparation of damaged or poorly functioning neuro-synaptic bridges in the brain that allow for the transmission of chemical messengers. It is strongly associated with increased glutamate transmission in the brain, which correlates to its antidepressant effects.10

Can Ketamine Support Addiction Recovery?

As mentioned earlier, ketamine has been found to be effective at sub-anaesthetic doses in the reduction of the symptoms and neurological states associated with severe depression. Ketamine’s antidepressant properties are ‘hypothesised to result from prefrontal cortex glutamate homeostasis’. Its effects ‘may improve ability to learn new behaviours11 and may be beneficial in the treatment of SUDs12.

Can Ketamine Be Used in the treatment of Anxiety Disorders?

There is an increasing body of research that suggests the importance of glutamate in mediating our stress response and how we form traumatic memories. Its soothing effect on the nervous system means that those suffering from persistent and severe anxiety may be able to find some much needed effective relief. Anxiety, as well as depression, can be complicated to treat, especially when there is unresolved trauma involved. Ketamine may be able to reduce the severity of clients’ anxiety and depression and, as with potential treatment for substance misuse, influence areas of the brain involved in memory recall and new memory formation.13

Clinical Use of Ketamine

Doctors are able to provide effective and fast-acting relief for individuals suffering from severe depression, anxiety disorders, chronic pain, OCD, and bipolar disorder with ketamine-infusion therapy.14 A nasal spray known as Spravato, with the main active ingredient Esketamine (or S-isomer ketamine), is being researched and used in clinical settings for clients suffering from treatment-resistant depression and other mental health issues.

Ketamine should only be used in clinical settings. Dosage must be managed carefully by a trained professional, who can also provide careful and effective supervision for clients receiving treatment. Ketamine is a popular street drug, so there are dangers to one’s health associated with obtaining ketamine outside of clinical administration.

Mental health clinics and hospitals across the country are beginning to incorporate ketamine-infusion therapy into their practice, but as mentioned earlier, the use of such treatment is only delivered by a small number of practitioners.

Conclusion

Depression is an extremely difficult condition to live with, but treatment options are available. Ketamine is a promising new treatment regarding severe depression, but other treatments have been found to be effective. If you or a loved are suffering from depression, anxiety, or a number of other mental health conditions, reach out to a doctor or other mental health professional. Following an initial assessment, an appropriate treatment plan can be devised and depression and other mental health can be managed.

 

 

 

 

 

1 Gordon, Joshua. “NIMH » New Hope For Treatment-Resistant Depression: Guessing Right On Ketamine”. Nimh.Nih.Gov, 2019, https://www.nimh.nih.gov/about/director/messages/2019/new-hope-for-treatment-resistant-depression-guessing-right-on-ketamine.shtml. Accessed 1 Dec 2020.

2 Li, Linda, and Phillip E Vlisides. “Ketamine: 50 Years of Modulating the Mind.” Frontiers in human neuroscience vol. 10 612. 29 Nov. 2016, doi:10.3389/fnhum.2016.00612

3 Ferrari AJ, Charlson FJ, Norman RE, et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med 2013; 10: e1001547.

4 “Depression”. Who.Int, 2020, https://www.who.int/news-room/fact-sheets/detail/depression. Accessed 1 Dec 2020.

5 Dadiomov, David, and Kelly Lee. “The effects of ketamine on suicidality across various formulations and study settings.” The mental health clinician vol. 9,1 48-60. 4 Jan. 2019, doi:10.9740/mhc.2019.01.048

6 Mandal, Suprio et al. “Efficacy of ketamine therapy in the treatment of depression.” Indian journal of psychiatry vol. 61,5 (2019): 480-485. doi:10.4103/psychiatry.IndianJPsychiatry_484_18

7 Corriger, Alexandrine, and Gisèle Pickering. “Ketamine and depression: a narrative review.” Drug design, development and therapy vol. 13 3051-3067. 27 Aug. 2019, doi:10.2147/DDDT.S221437

8 “John Krystal, MD”. Yale School Of Medicine, 2020, https://medicine.yale.edu/profile/john_krystal/. Accessed 1 Dec 2020.

9 Secko, David. “Depression: more than just serotonin.” CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne vol. 172,12 (2005): 1551. doi:10.1503/cmaj.050472

10 Abdallah, Chadi G et al. “The effects of ketamine on prefrontal glutamate neurotransmission in healthy and depressed subjects.” Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology vol. 43,10 (2018): 2154-2160. doi:10.1038/s41386-018-0136-3

11 Naughton M, Clarke G, Olivia FO, Cryan JF, Dinan TG. A review of ketamine in affective disorders: current evidence of clinical efficacy, limitations of use and pre-clinical evidence on proposed mechanisms of action. J Affect Disord. (2014) 156:24–35. 10.1016/j.jad.2013.11.014

12 Jones, Jennifer L et al. “Efficacy of Ketamine in the Treatment of Substance Use Disorders: A Systematic Review.” Frontiers in psychiatry vol. 9 277. 24 Jul. 2018, doi:10.3389/fpsyt.2018.00277

13 Becker B, Steffens M, Zhao Z, et al. General and emotion-specific neural effects of ketamine during emotional memory formation. Neuroimage. 2017 Apr;150:308-317. DOI: 10.1016/j.neuroimage.2017.02.049.

14 Costi, Sara et al. “Current Status of Ketamine and Related Therapies for Mood and Anxiety Disorders.” Current behavioral neuroscience reports vol. 2,4 (2015): 216-225. doi:10.1007/s40473-015-0052-3

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