Ketamine: A Safer, Faster Alternative to Oral Antidepressants
I'm Dr. Teresa Anderson, owner/operator/and practicing psychiatrist of The Anderson Clinic in Cincinnati, Ohio, and today we’re discussing a hot-topic on the airwaves: ketamine infusions for treatment-resistant depression and post-traumatic stress, or PTSD.
Some may have familiarity with ketamine as a party drug. Others may know about it if they have ever received an anesthetic in the emergency room for broken bones after a car accident. If you lived through the Vietnam Conflict, you might have even carried ketamine on your person during battle. It was considered a “buddy drug” because soldiers could administer it to a fellow who had been injured while they were waiting for the medic because it didn’t cause cardiovascular slowing.
Ketamine is a drug in a category known as “dissociative anesthetics.” It causes a person to not be psychically present during a procedure. At higher doses, it’s great when you need a patient to be without pain quickly and forget the painful procedure they’re getting ready to endure. At much much lower doses, it is one of the first rapid-acting antidepressants we’ve found.
While it has many mechanisms of action, and more research is emerging constantly, the most fascinating one to me is the fact that it increases communication between the neurons. Why do we care? If a brain cell or neuron is alive, it needs to be active. The main way it can be active is by communicating with its neighbors. But what if it doesn’t have a way to “plug into” its neighbor to communicate? A single infusion of ketamine has been shown, at least in animal studies, to increase the number of “plug-ins” or dendritic spines on a neuron. This is like adding extra USB ports onto your computer. This means improved neuronal neighborhood communication. That means decreased symptoms of depression, anxiety, and sleeplessness. It may even make the medications that you’re currently taking for these issues WORK BETTER than they did at baseline! All in a matter of hours to days instead of weeks to months. This has huge implications for folks who have tried every prescription antidepressant out there and have yet to find a combination that’s been helpful.
So if ketamine is such a wonderful antidepressant why haven’t we been using it all along for this purpose? Well, like a lot of happy accidents in medicine, we were using it as an anesthetic and didn’t realize that it had mood-boosting properties until much much later.
Even the very first antidepressant was initially used as an anti-TB drug when the doctors and nurses noticed in the sanitariums that the people on the floor of the hospital were found to be “unreasonably happy given their dire situation.” Another example is the medication topiramate, which was initially introduced as an anti-seizure med, then was found to radically decrease the number of migraine headaches people were having. It was then used in migraine prevention. Later on, people recognized that their pants were getting a little looser and their taste for sweets had completely disappeared. So then they studied and approved it for binge-eating disorder. So many good effects only found after the fact.
It takes BILLIONS (yes, with a “B”) of dollars for a drug to go from concept to mass-production, including quality and safety testing in humans. So in an effort to minimize that cost, medicine is now turning to familiar products and studying them in new ways to see if they may have more than just one use.
There’s good news and bad news about this. Because ketamine went generic in the 1970’s, nobody owns the “rights” to it per se. Any company that produces medications could theoretically produce ketamine. So no drug company wants to conduct millions of dollars of research so that other companies would potentially profit from. This is one of the reasons the ketamine is used in what we call an “off-label” fashion. It is NOT FDA-approved for treatment-resistant depression, anxiety or PTSD, but is prescribed regardless for those very reasons nonetheless. This is a less scary than you think: this is common practice for thousands of medications, and about 70-80% of what psychiatrists prescribe is actually considered “off-label.”
Certain “tweaks” have been made to the ketamine molecule, and these varieties HAVE been patented and ARE currently in use for mental health issues. But today we are keeping the conversation solely limited to intravenous ketamine infusions, as it is the variety of the medication that is the most bioavailable. Translated, that means your body absorbs exactly the amount it is given intravenously and can put it to good use.
Most treatment protocols start at a recommended dose studied by the National Institute of Health, using a protocol of between 1-6 IV infusions over the course of 1-3 weeks. Anything past the 3 week mark seems to be less effective. Each treatment lasts 45”- one hour and the outcome is widely variable.
During infusions patients are encouraged to relax and let their mind drift, some report the sensation of weightlessness while others may feel a numbness or tingling in their extremities or experience euphoria. Each patient will experience the infusion in their own unique way and individual experiences during the infusion do not necessarily predict outcomes.
There are people who get immediate relief of symptoms during the infusion, there are people who START feeling better once the treatment has been completed. Others may take several treatments before feeling a shift in their mood, or even start to feel better once the entire series is over. In our clinic we seem to have the most improvement with folks who suffer from mood disorders: depression, anxiety, and PTSD, about 70-80% of that population find that they receive at least 50% improvement from their baseline symptoms. OCD is much harder to treat, much like with standard oral antidepressants. But your age, your genetics, your health status, and the current types of medications you may be taking could also interfere with your response. That is definitely something you should ask your doctor about. Never abruptly stop taking a medication without first seeking out your physician.
The awesome part of IV ketamine treatment is how rapidly the medication has the potential to work! You can start feeling better the SAME day as the treatment starts, or in as little as a couple of days once treatment has begun as opposed to several weeks to months that oral antidepressants usually take. In many cases, it works when all other oral antidepressants have failed the patient.
Another awesome part of ketamine treatment is that the side effects are mainly limited to the duration of treatment or shortly thereafter (mild headache, mild dissociation, or mild nausea).
The less awesome parts include: needing a driver to take you home, being out of commission for the rest of the day, and the fact that its effects tend to be short-lived from a few weeks to a few months. It’s hard to guess who will respond and who won’t.
So the question is: why go through with all of this if it is short-lived? In actuality, nothing is a panacea or cure-all. You can’t walk 10 miles once and say you’re done exercising for the rest of your life, right? You can’t go to psychotherapy for one session and say “that’s it! I’m cured!” Ketamine, much like other medications and different types of therapy are just tools you can use to try to improve your functioning. It may be that you could go into complete depressive remission. It may be that it could make you stop feeling like you want to hurt or kill yourself. Or it may be the thing that finally gets you up, out of bed, and back to work. It could be the thing that allows you to reassess your stress level and minimize some of the burdens you’re feeling. And once your behaviors start changing, those behaviors can neurochemically reinforce the changes that the ketamine has made and vice versa. If it can improve your functioning on any level, or reduce your symptom load when nothing else has, it seems to me that it’s worth trying. It would be nice to get back to your life and actually living it instead of going through the motions. If what you’ve learned today has intrigued you, if you’re interested in further educational reading on the topic of IV ketamine for antidepressant purposes, you can download my ebook on Amazon: All is not Lost: Hope After Antidepressants Fail. It’s 99 cents. Cheaper than your cup of joe in the drive-thru.
Another one of my favorite sayings is: “Our greatest glory is not in never failing, but in rising every time we fall.” It’s one of the reasons the symbol of our clinic is a phoenix (not to mention the fact that the owner is a huge Harry Potter nerd). But it spoke to me that you can carry heavy loads, that you can be honest, loyal, and faithful, but still have trials that may burn you. After all this, you can most definitely rise from the ashes stronger and more resilient. Sometimes you just need a helping hand to do so.
If you found this blog post intriguing and would like to learn more about alternative treatments in mental health, visit us at www.andersonclinic.net or give us a call at (513) 321-1753. Follow us on IG at @TheAndersonClinic and check out our Podcast, Psych Waves on iTunes and Spotify. At The Anderson Clinic we pride ourselves on providing mental health solutions, not stigma.