Category

Psychopharmacology

Ketamine + Mindfulness Therapy Treats Cocaine Addiction

By Addiction, ADHD, Anxiety, Bipolar Disorder, Co-Occurring, Cocaine, Depression, Ketamine, Mental Illness, PsychopharmacologyNo Comments

This image shows cocaine addiction

A Single Ketamine Infusion Combined With Mindfulness-Based Behavioral Modification to Treat Cocaine Dependence: A Randomized Clinical Trial

Am J Psychiatry 2019; 176:923–930; doi: 10.1176/appi.ajp.2019.18101123

Elias Dakwar, M.D., Edward V. Nunes, M.D., Carl L. Hart, Ph.D., Richard W. Foltin, Ph.D., Sanjay J. Mathew, M.D.,
Kenneth M. Carpenter, Ph.D., C.J. “Jean” Choi, M.S., Cale N. Basaraba, M.P.H., Martina Pavlicova, Ph.D., Frances R. Levin, M.D.

A study recently published in the American Journal of Psychiatry found that Ketamine, an NMDA blocker that promotes synaptogenesis, plus Mindfulness Therapy effectively treated cocaine dependent patients. Fifty five cocaine dependent subjects were treated with either ketamine or midazolam combined with mindfulness behavior therapy. The study found that ketamine was significantly more effective in treating cocaine cravings and was associated with a significantly higher rate of abstinence than patients treated with midazolam, a medication used as a control. Craving scores were 58.1 % lower in the Ketamine group than the control group. At six month follow up, 44% of patients treated with Ketamine were abstinent compared with 0% of patients in the control group. The authors found that ketamine infusions given at a dose of 0.5mg/kg over 40 minutes was well tolerated, and promoted abstinence in cocaine addicted patients. Ketamine was associates with a lower likelihood of cocaine use, lower levels of cocaine craving and longer time to relapse. This study represents a promising treatment modality for cocaine addiction, an illness for which, until now, has had no effective treatments. 

Ketamine: An Effective, Novel Approach To Treating Depression

By Addiction, Anxiety, Depression, Ketamine, Mental Illness, PsychopharmacologyNo Comments

The purpose of this image is to show ketamine molecule

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.

 

This picture shows the mechanism of action of ketamine to treat depression

Fig 1.

Scott Bienenfeld, M.D. 

Stacey Cohen-Meissner, Ph.D.