One of the primary pursuits of TMS Health Solutions is finding innovative treatments for clinical depression. One such burgeoning form of treatment being researched by the mental health community is ketamine. Studies examining the effects of the drug on patients with clinical depression have occurred since the early 2000’s. Much is still to be learned about the long-term effects of the drug, but some research is showing encouraging findings. As compassionate advocates of a multi-faceted approach to fighting clinical depression, TMS Health Solutions would like to highlight some pertinent information surrounding ketamine.
Ketamine was created in the 1960’s to be used as an anesthetic for operating on soldiers in Vietnam field hospitals. Ketamine is widely known as being a “horse tranquilizer” but higher doses of the anesthetic are used by veterinarians for all sorts of livestock. Approved by the FDA in 1970 as an injection anesthetic treatment, people began to use ketamine recreationally. The popularity of using ketamine or “Special K” recreationally peaked in the 90’s and led to it being a Schedule III controlled substance in 1999. In the United Kingdom, over 90 deaths were reported from Special K use.
Clinical trials of ketamine for treating depression have occurred throughout the international community and have, at times, shown astonishing results. One of the primary draws to ketamine treatment is its rapid acting results. One study even suggest that ketamine can reduce symptoms of depression within 6 hours whereas most antidepressant treatments take 6 weeks for the effects to take effect. (2 Aan Het Rot M et al. Ketamine for depression: where do we go from here? Biol. Psychiatry. 2012 Oct 1;72(7):537-47.) This study looked at participants who had underwent other forms of treatment for clinical depression giving new hope to those with TRD treatment resistant depression. Another study showed that one of the quickest effects of ketamine was a significant reduction in suicidal thoughts and likened the drug to lithium or clozapine.
Scientist are still unsure about how ketamine reacts with the brain. Whereas antidepressants are intended to balance brain chemicals, it is believed ketamine alters the ways in which the brain cells interact with one another. Is thought that by blocking NMDA receptors for glutamate ketamine causes a rapid onset reaction. Ketamine also adjust opioid receptors which can affect the mood regulation in the brain.
The side effects and efficacy of ketamine are currently under discovery. Most patient’s report having an “out of body” experience within the first hour of being treated intravenously with ketamine. The benefits of the drug are not known to be lasting and can wear off within three days. Clinical ketamine treatment usually involves repeat sessions over the span of months or years to experience lasting improvements in one’s mental health. Studies show that ketamine treatment combined with psychological or behavioral therapy have longer lasting results.
Some concerns about the long-term side effects of ketamine linger. Specifically, issues with memory and cognitive functioning have been linked to ketamine use, but not necessarily with the doses associated with treating clinical depression. Scientist are also concerned with the potential for abuse as was seen with “Special K”. Going forward the National Institute of Mental Health is concerned with the ability of ketamine to interact with a specific brain target and whether, “this is related to some measurable change in brain or behavioral activity that, in turn, can be associated with relief of symptoms.”
The use of ketamine for treating clinical depression is in it’s infancy stage. Research on the drug has seen a lack in funding due to ketamine being a generic drug which pharmaceutical companies can’t patent. Although pharmaceuticals have recently begun developing drugs based on ketamine which can be patented. In 2016, the FDA designated esketamine as a breakthrough therapy. Esketamine is in phase III clinical trials and is administered through a nasal spray. Rapastinel, a drug based off of ketamine which effects NMDA receptors similarly received breakthrough therapy status in 2016.
The mental healthcare professionals at TMS Health Solutions will track the progress of several ketamine studies in the days to come. Our holistic approach to treating major depressive disorder and treatment resistant depression involves a cutting edge, ever-evolving approach to mental health. To track these studies with us, check out the U.S. National Library of Medicine’s site on ketamine here. (https://clinicaltrials.gov/ct2/results?cond=&term=ketamine&cntry=&state=&city=&dist=)