Ketamine, an anesthesia medication, is an old drug that has emerged over the past several years as a rapid and effective treatment for depression and suicidal thinking. Most people who seek out ketamine have tried other treatments such as medications and even psychotherapy with either little success, or an inability to tolerate side effects. Some people who have had earlier success with conventional antidepressants, have found that over time, efficacy has worn off.
Ketamine was approved in 1970 as an anesthetic, and since that time it has been widely used, mainly by anesthesiologists for that purpose. It has been used for decades to treat refractory pain syndromes. Unlike most anesthesia drugs, ketamine does not require that a patient be intubated since it actually opens the airways and increases circulation.
Ketamine is known as a “dissociative anesthetic” because at doses required for anesthesia, it causes hallucinations and feelings of dissociation – an “out of body” experience.
Ketamine is used at significantly lower doses to treat depression, and while patients receiving ketamine for this purpose often feel some dissociative feelings, they are of a much lower magnitude and most often described as being pleasant.
Ketamine for depression is usually delivered by IV infusion over a 45-50 minute period under the guidance of experienced, licensed staff. It can also be given as an intramuscular injection or even as a nasal spray.
After the infusion, most people relax for about 20-30 minutes and then go home accompanied by someone.
Many people feel better after only one infusion! However, many people do require several infusions before they notice improvement. Also, patients vary in terms of how long the benefits of ketamine will last.
Ketamine is normally well tolerated and treats depression via a different mechanism of action than other antidepressants. While most antidepressants work by blocking the re-uptake of serotonin, ketamine actually works by blocking another receptor called the NMDA-receptor which modulates the excitatory neurotransmitter known as Glutamate. In fact, lab experiments have shown that ketamine actually re-generates neurons in the brain that are damaged due to long-term depression. This is known as synaptogenesis (see Fig 1 below) which may also help explain ketamine’s mechanism of action.
If you are someone who has suffered from long-standing depression, or have had difficulty tolerating, or adequately responding to antidepressant medication, then ketamine may be appropriate for you.
Please call us for more information, or to be medically evaluated for Ketamine.
Scott Bienenfeld, M.D.
Stacey Cohen-Meissner, Ph.D.