Ketamine and Esketamine (Spravato) and Depression: An Introduction
Ketamine has received a lot of press in recent years, and has been hailed as a groundbreaking treatment for several psychiatric illnesses. This is the first in a series of articles that examines ketamine with a particular focus on its potential as a treatment for major depression.
What is Ketamine?
Ketamine was discovered in 1962, and introduced into medical practice as an anesthetic drug soon after, in 1970. Ketamine anesthesia was shown to have distinct advantages over other types of anesthesia, as it did not suppress respiratory and cardiovascular functioning. This was of critical importance, especially for patients who were critically ill, had respiratory problems, or those with low blood pressure.
Over time, ketamine anesthesia was found to cause side effects in some surgical patients, including a feeling of altered reality upon waking, and in some cases, hallucinations. Therefore, ketamine is no longer routinely used for anesthesia.
Use of Ketamine Outside of Anesthesia
The official use for ketamine, as defined by the FDA, is as an anesthetic agent. However, ketamine is increasingly used by physicians for off-label indications, such as sedation, pain relief, and for the treatment of psychiatric illnesses, particularly depression. In these situations, ketamine is administered intravenously in doses much lower than would be used for anesthesia. These off-label uses are supported by a growing body of carefully conducted research by top academicians and clinicians around the country.
The Positive Effects of Ketamine
One reason ketamine is so effective in these off-label uses is that it has a calming and sedating effect. In emergency care, it has been shown to effectively calm violent or agitated patients. In pediatric care, ketamine is effectively used to calm and sedate children who need to undergo a dental or minor medical procedure, or an MRI scan.
Ketamine also provides pain relief, and is often used in the emergency room and on the battlefield, and to treat patients who suffer from chronic pain. It has also been used to treat pain after major surgery, and to relieve severe headaches.
In addition, ketamine has been shown to serve as an effective treatment for several psychiatric illnesses, including major depression, and severe and treatment-resistant anxiety disorders, including obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD).
Use of Ketamine in Major Depression
Over the last decade, ketamine has made headlines as a dramatically effective treatment for major depression. Patients with major depression, who have not responded to conventional antidepressant medicines, even after years of treatment, have been found to recover within hours of receiving a ketamine injection. The antidepressant benefits of ketamine are short-lived however, and most patients need maintenance antidepressants. Ongoing research suggests that the antidepressant benefits of ketamine can be maintained with repeated dosing once every 3 – 4 weeks, and the safety of this practice continues to be explored.
Adverse Effects of Ketamine
There are very few adverse effects of low doses of ketamine, and those that do occur pass away on their own within a few hours.Patients who receive therapeutic ketamine are kept under supervision until side effects, if any, have disappeared.
Abuse of Ketamine
As with many mood-altering drugs, ketamine, which has psychedelic properties, may be recreationally used and abused. People who regularly abuse ketamine may suffer adverse medical consequences, including issues with the stomach, liver, and bladder, as well as cognitive impairments.
Abuse of ketamine does not occur when the drug is administered in a therapeutic setting, as it is administered in very small doses, and access to the drug is medically supervised. Ketamine abuse in clinical practice is rare, and serious adverse consequences, including death, are rare.
Key Takeaways of Ketamine Treatment for Major Depression
Ketamine is well tolerated when administered for therapeutic indications, including the off-label treatments described above, and particularly when administered in low doses. When administered properly, the benefits of ketamine far outweigh any concerns, especially for patients with treatment resistant depression.
If you or someone you love is suffering from treatment resistant depression, we encourage you to reach out to COPE to learn more about our innovative, effective, evidence-based treatments. Please call our office at COPE to schedule an appointment.