How Does Ketamine Work For Depression?
Ketamine is a street drug, anesthetic and an antidepressant for treatment-resistant depression; cases were conventional treatments such as antidepressants and psychotherapy are not effective. Ketamine can be given by nasal spray or infusion. It is not meant to be a long-term treatment due to its addictive properties; patients receive a few doses of ketamine and go on to continue with an antidepressant and/or psychotherapy.
Ketamine is an NMDA receptor antagonist but it is not exactly clear how it helps treat depression. It is believed that it increases the neurotransmitter glutamate in the synaptic clefts between neurons. Glutamate then activates AMPA receptors on other neurons, leading to the release of other molecules which help neurons communicate with each other, resulting in improved mood and cognition. It is very fast-acting and effective for depressed and suicidal patients (i.e., those walking into an emergency department after attempting to kill themselves).
Ketamine is effective for depression because it can rapidly reduce suicidality as well as depression combined with anxiety. While other conventional treatments such as antidepressants and psychotherapy take weeks or even months to work, ketamine is very fast-acting and works within hours to days.
There is racemic ketamine (IV ketamine) which is given as an infusion into the bloodstream. It was approved many years ago by the FDA as an anesthetic. Currently, it is used off-label to treat depression; some patients respond after 1-3 infusions. Esketamine or Spravato was FDA approved in March, 2019 and is given as a nasal spray.
IV ketamine may cause nausea and vomiting, high blood pressure, perceptual disturbances and out-of-body experiences. Esketamine nasal spray may cause the same side effects.
Overall, depression can be a very daunting mental illness that may take years to resolve. Besides SSRIs, ECT and ketamine, one of the best treatments is to find a close friend, family member or therapist and open up about your thoughts, feelings and emotions. Depression is often triggered by life events that can be worked through via consistent talking over time.
No matter how deep your depression takes you, never give up! There is always hope!
Are you Ready? (This is Defeating Stigma Mindfully)