Ketamine therapy is an increasingly common way to relieve severe symptoms of depression. If a depressed person responds to the therapy, it can drastically reduce suicidal thoughts and other life-threatening acts. Here is a review of the therapy, how ketamine works, who is eligible to use it, and the side effects.
The Different Types of Ketamine
Medical experts and therapists use two main types of ketamine to treat depression that doesn’t respond to conventional therapy, such as antidepressants.
The first type is racemic ketamine, often given as an infusion and mainly referred to as IV or intravenous ketamine therapy. Racemic ketamine is a combination of two mirror-image molecules – R and S ketamine. Racemic was approved for use by the FDA, and now its off-label use is treating depression.
The second type is Esketamine (Spravato), which the FDA also approved, and it’s administered as a nasal spray. Unlike the former, it only has the “S” molecule. Mostly, people seem to prefer infusion ketamine, and there has been extensive research on the same. The two types interact with various receptors in the brain, thus treating symptoms of depression. The way the ketamine is delivered determines the drug’s effectiveness and side effects.
The Ketamine Treatment Process
Ketamine therapy isn’t the first-line treatment of depression. It is given when other drugs and therapy don’t work. Ketamine is administered through an IV infusion in your arm, and the effects typically last from days to weeks, although more research is required. It is administered in a sequence, whereby the patient receives an infusion the first week, two in the second week, then once weekly for the following three weeks. For the maintenance dose, you get the infusion once per month. Besides treating depression, ketamine is also used in bipolar disorder, but it’s contraindicated for mania, active psychosis, and cardiovascular disease patients.
How Does Ketamine Work?
Ketamine can help manage depression when other medications haven’t worked. Research doesn’t yet show how exactly ketamine works, but it exerts an antidepressant effect. It targets the NMDA receptors in the brain by binding to them, thus increasing a neurotransmitter known as glutamate. Glutamate activates the connections in the AMPA receptor, and together they release other molecules that aid neuron communication. The whole process is called synaptogenesis, and it affects a person’s thought patterns, mood, and cognition.
Ketamine also influences depression by reducing the signals of inflammation. In some ways, inflammation is linked to mood disorders, and since ketamine reduces the signaling, it might effectively change the communication with certain areas in the brain.
Major Side Effects of Ketamine
Like any other drug, ketamine also has some side effects, but the good news is that the possible benefits typically outweigh the risks. Ketamine therapy may cause the following side effects:
- High blood pressure
- Nausea and vomiting
- Perceptual disturbances such as changes in time, color, texture, appearances, and so on
- Dissociation (also known as out-of-body experience)
Side effects like change in perception and dissociation are more common after the first infusion but normally end very soon afterward.
Who is Eligible for Ketamine Use?
A lot of caution should be observed when ketamine is in use. It is an effective treatment that reduces symptoms of depression, but there haven’t been enough studies to show the adverse effects, especially for long-term use. The main setback is that the beneficial effects wear off after several days, so you have to get the infusions regularly. In high doses, ketamine can cause bladder damage and toxicity to the brain cells. It can also cause some psychotic-like symptoms during the infusion. That’s why you should take a lot of caution during therapy. Anyone with depression or bipolar disorder is eligible for the treatment, but it’s contraindicated for children and high blood pressure, mania, and alcoholism.
Summary
More help is needed in treating depression since more and more people seem to get affected. There are increasing cases of suicide, and this should be put to a stop. Ketamine steps in to treat depression that’s resistant to drugs by changing a person’s mood, thought process, and cognition. A high percentage of patients treated with ketamine walk away feeling better, and this is enough proof that ketamine works for depression.
