treatment for depression

 

ketamine treatment for depression

ketamine treatment for depression has also been used in cases of bipolar disorder, but it is not indicated for patients with active psychosis, mania, or unstable cardiovascular disease, Dr. Levine says. Nor is it indicated in children, he adds.

What Does a Ketamine Treatment Consist of?

Rather than being a first-line treatment, Dr. Levine says, ketamine is given when other antidepressants don’t work. It’s administered by an IV infusion in the arm, and typically the effects last for anywhere from days to weeks.  “Generally, it’s administered in a tapering sequence in which patients receive three infusions the first week, two in the second week, once weekly for the next three weeks, and then moving to maintenance of, on average, once per month,” Dr. Levine says.

Ketamine has also been used in cases of bipolar disorder, but it is not indicated for patients with active psychosis, mania, or unstable cardiovascular disease, Dr. Levine says. Nor is it indicated in children, he adds.

Providing Help for Veterans

In addition to depression, ketamine may ease the post-traumatic stress disorder (PTSD) that many veterans experience. PTSD, a mental health problem that people can develop after experiencing some type of trauma, such as combat, can be treated effectively with ketamine, says Aimee Cabo Nikolov, BSN, who with her husband, Boris, runs the Ketamine Medical Clinic, a division of the Neurosciences Medical Clinic, in Miami.  “Some researchers have called ketamine the most important discovery in half a century,” Nikolov says, adding that about 35% of the patients in their clinic are military veterans seeking treatment for PTSD. “For many veterans suffering from PTSD, ketamine is providing hope after other kinds of treatment didn’t give them the results they needed,” Nikolov says.

At the Ketamine Medical Clinic, where around 105 patients have been treated with ketamine, between 75 and 80% felt better on the treatment as compared to more traditional medications for depression. “That rate is around 35 to 40%,” Nikolov says. 

Is Ketamine Safe for Everyone?

Some mental health experts advise caution where ketamine is concerned. “Although it can be an effective treatment for rapidly reducing symptoms of depression, we don’t yet know enough about its potentially negative consequences, especially from long-term use, for me to recommend it as an option for most patients,” says Bryan Bruno, MD, a psychiatrist at Lenox Hill Hospital in New York City.

The main drawbacks, he says, are that the beneficial effects of the drug wear off after 7 to 10 days, so most patients have to get infusions on a regular basis. “Some research studies have demonstrated that it can be toxic to brain cells and cause bladder damage, especially at higher doses,” Dr. Bruno says. “It can also cause psychotic-like symptoms during the treatment.”

Still, Dr. Bruno says, ketamine can help some individuals with depression. “It can be beneficial, especially to those who require immediate improvement who have failed conventional FDA-approved treatments,” Dr. Bruno says.

Currently, research is underway on ketamine’s long-term effects, safety and optimum doses in clinical trials. 

Ketamine Side Effects

The side effects of ketamine may include dissociative changes that are nearly always mild and transient, if they occur, as well as temporary elevation of heart rate and blood pressure often occur. These effects are usually well tolerated and usually don’t result in the discontinuation of treatment ketamine treatment for depression.

“During the infusion you can feel floaty or disconnected, but that typically lasts only about 45 minutes. Some people also feel a little bit of nausea” Dr. Levine says. “For those who benefit from ketamine the response tends to feel different than the emotional smoothing of SSRIs. People often describe a clarity of thinking, lifting of the weight of depression and an increased functional capacity which can take effect within the first few hours following treatment.”

Nicole Bayman has had no lasting side effects, although she says that when getting the infusion, “It is almost like a high but it can be very intense.”

Molly Shea, 29 feels as if she is in a twilight sleep when she is getting the infusion of ketamine.  She gets an infusion every three weeks, and the entire treatment takes about 90 minutes. During the procedure, she experiences drowsiness, but it’s not intolerable. “It’s like a twilight sleep and I know where I am and can hear during the whole time,” she says. “I can open my eyes and see, too, but I generally don’t want to because of the colors and ideas and things that are unfolding. I feel like I am thinking from a different part of my brain while I’m getting the treatment.”

As for the potential to become addicted to ketamine, once used as a “party drug,” Dr. Levine says it’s just not there. “Studies show that in the very low doses we use, in a medical setting, with lack of access at home and infrequent dosing, there is virtually no potential for addiction or abuse,” he says adding one caveat: “Benzodiazepines [Valium, Xanax, Adivan]  may blunt the antidepressant effect of ketamine.”

The High Cost of Ketamine

Unfortunately, ketamine is not usually covered by insurance—at Dr. Levine’s office, it costs $300 to $450 per treatment. Molly Shea doesn’t know how long she will be able to stay on ketamine as her treatments aren’t covered by her insurance. But Dr. Levine says the insurance issue may be improving soon.  “I’m really starting to see encouraging changes. Insurance companies are reaching out and covering treatment or considering covering it,” he says.

In the meantime, some patients are willing to bear the cost. Nicole Bayman, who is getting ready to go back to work, has no plans to stop taking ketamine. “It has been so incredible,” she says. “I feel like I have my life back.”  

Ketamine and Suicide

Sadly, suicide is a major public health concern and a leading cause of death in the United States. According to the Centers for Disease Control and Prevention (CDC) there were more than twice as many suicides (44,965) in the US as there were homicides (19,362) in 2016, the most recent year data is available. Also in 2016, suicide was the 10th leading cause of death overall in the US. More people die by suicide than breast cancer annually.

[Learn More About the Recent Approval of Esketamine to Treat Suicidal Ideation in the ER]

Clearly, more help is needed to address what many experts consider a national crisis. Dr. Levine believes the increase in suicides speaks to our limitations as a field and a society with identifying who is most at risk and having effective strategies to address it.

“Of the more than 3,000 patients we’ve treated with ketamine, I feel confident saying that the treatment likely spared hundreds of lives,” Dr. Levine says. “That’s the kind of significant and immediate impact ketamine can have.”