Ketamine Treatment For Depression

There are many treatments for depression available to you. They include:

  • Psychotherapy options such as Cognitive Behavioral Therapy (CBT), Interpersonal Therapy (IPT), and psychodynamic therapy
  • Medications such as Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors (SNRIs), atypical antidepressants, tricyclic antidepressants, and monoamine oxidase inhibitors (MAOIs)
  • Eye Movement Desensitization and Reprocessing (EMDR), Emotionally Focused Therapy (EFT), dynamic neural training, and other treatments

Your physician or mental health specialist prescribes the best treatments to help you get back to a good daily quality of life.

Patients who may be appropriate for ketamine treatment for depression have tried some of these other treatments already. They haven’t worked well enough, aren’t working fast enough, or aren’t working at all. Ketamine is another treatment available to you.

Benefits of Ketamine

Ketamine treatment for depression offers benefits many other treatments do not. For patients who respond well to treatment, the biggest benefit is how fast ketamine works. Numerous studies have shown that patients can have a rapid relief in symptoms. More studies are underway.

Overall, about 70% - 75% of patients who get ketamine treatment for depression experience positive results. Different studies report different success rates. Like any treatment for depression, not all patients will have positive results. It’s also important to know that ketamine isn’t a cure for depression, but rather an adjunct to improve your current therapy; it’s a better way to help you overcome your depression.

What’s Treatment With Ketamine Like?

Ketamine, an anesthetic that’s been used since the 1960s, was found to have unexpected and profoundly beneficial psychological effects. In general anesthesia, the goal is to put the patient to sleep. Compared to a hospital setting, patients with depression receive ketamine at a much lower dose over a shorter period of time. The infusion is controlled and can be tapered down to the patient’s needs.

Ketamine is given intravenously while the patient is on a cardiac monitor to continually assess their vital signs. Patients receiving ketamine treatment for depression often describe the feeling as floating, or an out-of-body, “loopy” experience. Short term side effects are feelings of dissociation of mind and body, disorientation, and visual hallucinations. Patients can wear an eye mask during treatment to avoid any visual disturbance. Some patients may feel a temporary numbness to hands, feet, and around the mouth. Some patients may feel nauseated toward the end of a treatment. Some patients may have an elevation in their blood pressure and heart rate. This is usually transient and resolves after the infusion is finished.

First Hand Experiences With Ketamine For Depression

Here are descriptions from patients (not with us) who have described their experiences publicly:

Protocol For Ketamine Treatment For Depression

Protocol For Ketamine Treatment For Depression

Pre-Treatment Evaluation

Each patient must have documentation of their diagnosis of depression from a qualified mental health professional. The first step is for the patient to complete diagnostics for depression, anxiety, drug abuse, psychosis, and alcohol abuse before a medical screening exam. All test results are shared with the patient’s providers.

The next step is for the patient to complete a medical exam with Dr. Manno. Dr. Manno will review the patient’s medical history and discuss what to expect during the treatment experience.

Induction Treatment Phase

The induction phase of ketamine treatment for depression is two infusions per week for two weeks. For each treatment, the patient will receive a slow intravenous infusion starting at 0.5 mg/kg of ideal body weight. If the patient has little response to the initial treatment, the dosage will be increased up to a maximum of 0.75 mg/kg ideal body weight.

Each infusion lasts 45 minutes; after that it takes about another 45 minutes for the patient to feel back to normal. Patients must arrange to have someone take them home after treatment.

Booster Treatment Phase

Patients will need periodic infusions of ketamine to maintain the therapeutic effects. Frequency of maintenance infusions will depend upon patient response. Each patient is unique and the treatment regimen will be determined by the physician.

Post Induction Monitoring

After the two weeks of treatment have been completed, patients will take the same diagnostic tests given before the Induction Phase. We do this to compare patient responses to their baseline and measure the effectiveness of treatment. All results will be shared with the patient’s providers.

Risks and Contraindications

Patients with uncontrolled hypertension, severe heart disease, active psychosis, or in a manic phase of bipolar disorder, or are taking methamphetamines, cocaine or other stimulants should not receive ketamine treatment. Patients who are chronically taking benzodiazepines, such as xanax, valium, ativan, can have a blunted response to ketamine, and should have their mental health professional or primary physician see if they can decrease their dosage prior to treatment.

Research on Ketamine Treatment For Depression

Research into ketamine treatment for depression is ongoing. Here is a sample of studies published and available to the general public or through a PubMed subscription

Source of these summaries: askp.org

  1. Murrough, Perez, et al. “Rapid and Longer-Term Antidepressant Effects of Repeated Ketamine Infusions in Treatment-Resistant Major Depression”  Biological Psychiatry2013 Aug 15; 74(4): 250–256.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725185/

SUMMARY:  In this article, there were 24 patients treated with six IV infusions of ketamine (.5mg/kg) over 12 days.  The overall response rate was 71% as defined as a reduction in the MADRS scale by  greater than 50%.  The median time to relapse after the last ketamine infusion was 18 days.  25% were symptom free at 90 days, 75% of patients had symptoms free days between 11-27 days.  Side effects were reported to be a mild significant increase in dissociative symptoms.  One patient had to discontinue therapy due to an increase in blood pressure that did not respond to medications (highest BP 180/115).

  1. Shiroma, Johns et al. “Augmentation of response and remission to serial intravenous subanesthetic ketamine in treatment resistant depression” Journal  of Affective Disorders.2014 Feb;155:123-9.

http://www.jad-journal.com/article/S0165-0327%2813%2900778-7/abstract

SUMMARY:  In this article, there were 14 patients treated with six IV infusions during a 12 day period.  12 subjects finished all six infusions with 92% response rate and 66% went into remission.  5 out of 11 responders remained in “response status” during the next 28 days.  For the 6 out of 11 responders that relapsed, the mean time was 16 days.  Response was defined as ≥50% improvement in baseline MADRS score and remission was defined as MADRS score ≤9.  No subject experienced severe dissociative symptoms or hemodynamic changes that required stopping the infusions.

  1. Sanacora, Frye, McDonald, et al.  “A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders”  JAMA Psychiatry. April                                     2017;74(4):399-405.

http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2605202

SUMMARY:  This review and consensus statement provides a general overview of the data on the use of ketamine for the treatment of mood disorders and highlights the limitations of the existing knowledge.  The suggestions provided are intended to facilitate clinical decision making and encourage an evidence-based approach to using ketamine in the treatment of psychiatric disorders considering the limited information that is currently available. This article provides information on potentially important issues related to the off-label treatment approach that should be considered to help ensure patient safety.