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Ketamine: An Antidepressant Treatment

Ketamine has been shown to improve depressive symptoms such as suicidal thoughts.

Ketamine: The Promising New Treatment

Ketamine is an anesthetic used by medical practitioners with anti-inflammatory effects. It has been described as having antidepressant properties for over 20 years (1). Its potential to become a widely used treatment for depression has been growing into a more active pre-clinical and clinical research topic. However, ketamine itself is not a new topic. For years, ketamine at much higher doses has been used for other purposes such as an anesthetic and sedative for people. Veterinarians have also used it. Ketamine is a promising new treatment for the following conditions, among others (2):

  • Treatment-Resistant Major Depressive Disorder
  • Suicidal Ideation
  • Bipolar Disorder
  • Post-Traumatic Stress Disorder
  • Generalized Anxiety Disorder

Ketamine’s Antidepressant Properties

The use of ketamine in clinical settings has been increasing over the years because of how quickly it begins to reduce symptoms of depression (1,3). More specifically, ketamine has been shown to reduce suicidal thoughts (4). This makes it a great emergency option for patients with depression in psychiatry. In randomized, placebo-controlled, double-blind studies, researchers found that the antidepressant effect of ketamine manifests in 80 minutes (3). Furthermore, ketamine reaches maximum efficacy at 24 hours and retains the effect for up to 7 days (3). The rapidness and its specific impact on suicidal ideation make ketamine a unique form of treatment since no other evidence-based treatments produce this combination of effects. Ketamine also addresses anhedonia as a symptom.

How It Works

Ketamine works by blocking postsynaptic GluN2B NMDA receptors and NMDAR on GABA interneurons found in the brain (3). This increases BDNF levels. The molecular and cellular responses to ketamine that follow then increase synaptic plasticity. When there are abnormalities in neurotransmission and neuronal plasticity, it may lead to irregular network functional connectivity (1). Network dysfunction in relation to altered brain levels of GABA has been found in people with depression.

Modes of Administration

There are many different modes of administering ketamine. It can be intravenous and non-intravenous. Non-intravenous methods include those through the muscle, nose, mouth, skin, and under the tongue—studies examining the antidepressant effects primarily used nasal sprays and intravenous transfusions at low single doses. There is not a lot of data available about repeated higher doses.

Recently, the intranasal (S)-ketamine has been approved for depression by the Food and Drug Administration (1). Spravato is an esketamine nasal spray that contains 28mg of esketamine. Patients usually prefer this method because it is non-invasive compared to the intravenous method (5). Patients who use the nasal spray will do so under the supervision of a medical professional.

The Potential of Ketamine

What’s great about ketamine is that it can produce these antidepressant effects on people with treatment-resistant major depressive disorder and bipolar disorder (4). With ketamine, there is hope for people with treatment-resistant depression, researchers who specialize in depression, and medical practitioners. Ketamine promises the new availability of a rapid-acting and robust antidepressant. Its quick onset and target on suicidal thoughts are of great importance in emergencies and as a prototypical form of suicidal treatment. Ketamine offers a new source of relief.

Advisory

Please note that this blog is meant to serve as a learning resource and is not professional advice. Seek a medical professional to see if ketamine is right for you.

References:

References:

  • Corriger A, Pickering G. Ketamine and depression: a narrative review. Drug Des Devel Ther. 2019;13:3051-3067. Published 2019 Aug 27. doi:10.2147/DDDT.S221437
  • Harbor Ketamine Clinic and Treatment Center. Keratin Infusion Therapy. Harbor Psychiatry & Mental Health. https://harbormentalhealth.com/ketamine-clinic-orange-county-ca/
  • Górska N, Slupski J, Szalazh LP, et al. Magnesium and ketamine in the treatment of depression. Psychiatria Danubina. 2019,31(3): 549-553.
  • Zarate CA Jr, Niciu MJ. Ketamine for depression: evidence, challenges and promise. World Psychiatry. 2015;14(3):348-350. doi:10.1002/wps.20269
  • D’Amore Mental Health. Esketamine treatment. D’Amore Mental Health.com. https://damorementalhealth.com/orange-county-mental-health-treatment/esketamine-treatment/