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vsubra6
May 82 min read

Ketamine, A New Treatment Option for Treatment-Resistant Depression

By: Dr. Vijay Subramaniam, DO


You have probably heard on podcasts, in the news, and even from your doctor about exciting new treatment options for depression involving the use of psychedelic drugs. According to the National Institutes of Health (NIH), drugs such as psilocybin, the active ingredient in mushrooms, and MDMA, or Ecstasy, are promising treatments for treatment-resistant depression. Treatment-resistant depression refers to individuals who have tried several other medications for depression with no improvement and may continue to experience suicidal thoughts. Now you may be wondering, How do these drugs help treat depression? Although the exact mechanism is unclear, these drugs seem to encourage the development of new connections between brain cells, known as plasticity.


Recently, another psychedelic drug has been gaining ground in the treatment of severe depression, called ketamine. The drug, better known as "PCP," “Angel Dust," or “Special K,” gained popularity for recreational use for its ability to cause dissociation, euphoria, and forgetfulness. Over the years, ketamine has been used in hospitals and veterinary clinics to put patients and animals to sleep during procedures and for severe pain. However, in 2019, the FDA approved a nasal spray prescription of ketamine called esketamine (Spravato) for the treatment of severe treatment-resistant depression after studies demonstrated decreases in depression scores of participants in the study versus the placebo group. Longer-term studies have also been done by Dr. Ella Daly, which found that esketamine combined with an antidepressant helped patients with severe depression stay in stable remission compared to an antidepressant plus a placebo. While antidepressants can take four to six weeks to take effect, ketamine can work within about forty minutes. Unlike other antidepressants, esketamine must be administered under the supervision of a certified physician or clinic to monitor your heart rate, blood pressure, breathing, and any severe side effects.


What side effects can you expect with ketamine? Side effects include dissociation, sedation, high blood pressure, headaches, blurry vision, nausea, vomiting, and intoxication.

So how does ketamine work? Although the exact mechanism is not known, the drug has been found to work on several receptors, including opioid receptors and NMDA. Further research is being done to find out why the drug is effective for severe depression.


Should you consider ketamine? If you have tried several medications with no improvement, ketamine may be an option for you. However, ketamine is avoided by individuals with a history of psychosis, schizophrenia, substance abuse, and the elderly with dementia due to its addictive and dissociative effects. Due to concerns about long-term effects on developing brains, the drug is also avoided in children and adolescents. While more research is needed to determine its safety and effectiveness long-term, for patients experiencing suicidal thoughts or with a history of suicide attempts, it can be a life-saving treatment. Before considering it as an option, consider the side effects and discuss it with your primary care physician or psychiatrist.





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