Is it time you consider Ketamine to treat Depression?
February 28, 2021
Based on NIH statistics https://www.nimh.nih.gov/health/statistics/major-depression.shtml in 2017 an estimated 11 million U.S. Adults aged 18 or older had at least one major depressive episode with severe impairment, and another 17.3 million had a major depressive episode without severe impairment. The total comprises around 8.5% of the U.S. population at the time these statistics were collected.
What is treatment-resistant depression?
Many of those with depression noted in the statistics above sought care with a mental health professional such as a psychiatrist, a therapist, or a combination of both. Others opted for medication only, usually prescribed by their primary care doctor. Approximately 60% did not seek care at all.
Many of us are familiar with the most common type of medication prescribed for depression: SSRIs. These are first-line medications for most patients suffering from major depression. There are several other classes of medications we review further in this video discussing Ketamine and how it differs from other classes antidepressant medications.
Treatment-resistant depression is noted in approximately 30% of those patients taking traditional oral medications. Treatment-resistant patients fail to achieve any meaningful improvement in their symptoms despite trying multiple medications. People with treatment-resistant depression often feel that hope is lost because all avenues have been exhausted. Fortunately, this is no longer true.
Discovered in 1956 and approved for use in the U.S. in 1970, Ketamine was a revolutionary anesthetic used extensively during the Vietnam war due to its high margin of safety. Over the years, however, Ketamine has developed a stigma as the result of its abuse as a street drug. When taken at doses 10x greater that its therapeutic dose for depression, Ketamine is dangerous and can cause severe adverse health effects. The stigma that comes from Ketamine’s abuse as a street drug often skews public and professional opinions of Ketamine and makes its legitimate use to treat mood disorders more challenging.
How does Ketamine treat depression?
The precise nature of Ketamine’s effects in the brain are still being worked out by scientists. Our page on the Science of Ketamine delves into what we know about ketamine’s action in the brain. We know that Ketamine reduces the toxic over-stimulation by the neurotransmitter glutamate, which has built up over time from chronic psychological stress and leads to the damaging of connections between neurons. Ketamine has been shown to facilitate the formation of new and beneficial neural pathways and synaptic connections. Furthermore, the beneficial effects are often seen to come in hours to days, rather that weeks to months as with oral medications.
How is Ketamine Given?
Ketamine can be given orally, as a nasal spray, IM (shot in the muscle), or IV. Although head-to-head studies have not yet been performed to compare them, much anecdotal and observational evidence is present to discuss the differences between treatment types.
Ketamine troches are an oral lozenge form, and their use is primarily to extend the therapeutic effect between intranasal, IV, or IM treatments. Troches are not used as a primary source for ketamine therapy.
The intranasal spray, brand named Spravato, is the only FDA approved ketamine formulation to treat depression. It has been criticized as having low and unpredictable bioavailability (poor absorption) and, anecdotally, has delivered relatively lack luster results. Furthermore, patients are still required to come to the clinic to get their dose and wait for 2 hours after the dose to be monitored.
Ketamine given intramuscularly has dramatically better absorption than the intranasal route, but the dose is given all at once when it is deposited in the muscle, making the drug delivery less controlled and adjustable to the patient’s needs and tolerance.
Finally, Ketamine IV has 100% bioavailability (complete absorption), and dose delivery can be carefully controlled to provide a sustained infusion over 45 minutes. Most studies of ketamine for the treatment of depression, anxiety and PTSD have used an IV protocol.
How do I choose a Ketamine Clinic?
With the increasing recognition of Ketamine’s potential in the treatment of depression, anxiety and PTSD, clinics have begun opening all throughout the nation.
When choosing the best provider for you, several factors should be considered:
- Is the practice run by Physicians, CRNAs, Nurse Practitioners, or Physicians Assistants?
- If Physician run, are the doctors Anesthesia, Emergency Medicine or Psychiatry Trained?
- Are there comfortable private rooms or chairs separated by curtains?
- How is the treatment being monitored to ensure safety?
- Can the doctors be reached if I have questions or concerns?
Why MD Infusions
At MD Infusions we provide the best mix of characteristics you should be looking for in a Ketamine clinic. We are physician run. A doctor is always present and initiates all the Ketamine infusions personally.
Our physicians are Emergency Medicine trained and currently practicing. By its nature emergency medicine requires doctors to have experience treating every type of health emergency and mental health crisis. We have been safely using Ketamine as an anesthetic for over 15 years at doses 3-4x times higher than those used for mood disorders.
Our nurses are also Emergency Department trained. They are experienced at starting the most challenging IVs under the most stressful circumstances. Our nurses are very skilled when it comes to caring for patients undergoing Ketamine therapy.
Our rooms are private and comfortable. We provide in-room air purification, plush blankets, eye shades, drinks, and soothing music during your therapy.
We perform vital signs before and after therapy. We also have continuous video and cardiac monitoring during and after therapy.
Lastly, we pride ourselves on having doctors available to you during therapy and between visits. We use OSMIND to track your treatment progress and encourage you to reach out to us. The “MD” in MD Infusions is there to emphasize that we are here for you.
If you are interested in learning more about us, please call 844-INFUSE4 (844-463-8734). Consultations are always free!