Affecting roughly 7% of American adults every year, depression can be utterly crippling and life-halting, as anyone who suffers from it will confirm. It’s not a new condition; depression has been with us for centuries, endemic to just about any organized society. Consequently, there is no shortage of treatments for the disease, with the term antidepressant representing a diverse category of pharmaceutical products, each with its own particular strengths and weaknesses. Selective serotonin reuptake inhibitors and serotonin/norepinephrine reuptake inhibitors, monoamine oxidase inhibitors, and tricyclic antidepressants have been in use since the 1950s, becoming the de facto drugs prescribed to treat depressive disorder.
Still, they aren’t always effective. While most countries’ psychiatric professionals routinely prescribe them, a third of clinically depressed patients just don’t respond to the “big four” antidepressants. Those who undergo full courses of at least two antidepressant drugs without showing signs of improvement are diagnosed with treatment-resistant depression. It’s also understood that these drugs can actually lose their effect over time. Treatment resistant depression can feel particularly frustrating, disheartening, and defeating, especially when psychiatric practices and institutions seem to lean so heavily on traditional antidepressants.
Fortunately for patients suffering from TRD, the growing prevalence of the disorder has led to a wave of alternative treatment options, some with stunning success rates.
The turn of the 21st century saw ketamine recognized for its potent antidepressant action after generations of frequent use as a reliable tranquilizer and safe anesthetic. It was soon adopted as an alternative to traditional antidepressants and lauded for its effectiveness when compared to those drugs. To many mental health professionals, ketamine represents a new direction for the study of depressive disorders and research into their treatment.
In most cases, the clinical application of ketamine takes the form of an intravenous delivery under the care and supervision of a licensed ketamine technician and in a professional medical setting. Technicians will typically have a professional and educational background in psychology or mental health treatment; their patient-facing role is that of a coaching therapist, helping patients navigate, understand, and ultimately benefit from the effects of the drug. Rooms designated for ketamine therapy will feature furniture, decor, and lighting that are conducive to relaxation. Commonly, patients will lay down and close their eyes while the drug is administered and throughout the period of treatment.
Unlike traditional antidepressants, ketamine is fast acting. While the effects of SSRIs, SNRIs, MAOIs and TCAs won’t manifest in patients until the drug has sufficiently built up in their systems, ketamine’s effects on brain chemistry are noticeable within hours of treatment. Ketamine also displays none of the common, unsavory side effects of traditional antidepressants, such as:
- Increased appetite and subsequent weight gain
- Decreased libido
- Digestive discomfort
- Insomnia and oversleeping
However, ketamine is not entirely without its drawbacks. While the dose administered intravenously during therapy sessions is sub-anesthetic — less than the amount typically needed to induce numbing, tranquilizing, and dissociative effects — some patients may still experience mild hallucination, the sensation of floating, and visual anomalies. Because these side effects are somewhat unpredictable, patients are not authorized to transport themselves by car to and from the session; a friend, family member, or chauffeur must be responsible for transportation. Ketamine’s potential for habituation means those with a history of substance abuse and addiction may wish to avoid this treatment.
In general, the potential drawbacks of ketamine therapy are considered by most patients to be minor and manageable, unlike the long-lasting and pervasive side effects of traditional antidepressants.
Ketamine therapy, while undoubtedly effective, is not a one-and-done treatment. A full course of ketamine infusions is normally six sessions spaced out over two to three weeks. Those who complete a course of ketamine therapy have reported lasting positive effects including the remission of depression symptoms. It’s not uncommon for patients to return for “booster” sessions following the initial treatments, in what is considered a “long term maintenance phase.”
According to Dr. Fahimian of Bespoke Treatment, ketamine treatment has exponentially increased success when used as part of a holistic treatment to include other psychological therapies. In his practice, the treatment is most commonly coupled with cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), or eye movement desensitization and reprocessing (EMDR) depending on the patient. Instead of treating ketamine as a one time cure-all, a personalized treatment plan leads to dramatically higher success rates.
While intravenous injection is considered the ideal mode of delivery, the invasive nature of the procedure has inspired the development of ketamine nasal spray. Marketed under the brand name Spravato, ketamine nasal spray is actually an esketamine solution; where ketamine’s molecular structure is composed of two mirror-image molecules, S- and R-ketamine, esketamine is composed only of the S-ketamine molecule. Like intravenous ketamine, nasal esketamine is administered under professional care and supervision, but is more suited for regular, long term treatment situations than intravenous ketamine.
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