With the dangers of ketamine in recreational use but the benefits with psychiatric treatment, what is the truth about Ketamine?
Scientists at Stanford University recently held a randomized, double-blind, crossover trial to see if the anti-depressive effects of ketamine were generated by activation of the brains opioid system, which controls pain, reward, and addictive behaviors. The study was published in the American Journal of Psychiatry. Allan Schatzberg, MD, shares senior authorship of the published paper with Carolyn Rodriguez, MD, PhD. Dr. Schatzberg suspected ketamine’s effects could be opioid related after Dr. Rodriguez published a report on the effects of ketamine on obsessive-compulsive disorder. He noticed a similarity in the data to other Stanford research using the opioid morphine.
Ketamine Drug Trials
The trial enrolled adults with treatment resistant depression (TRD). Twelve participants received two separate infusions of ketamine, one preceded by a placebo and one preceded by a dose of naltrexone, an opioid blocker. Following the placebo and infusion, more than half of the participants experienced 90% reduction of depressive symptoms for three days. In comparison, none of the participants experienced any reduction in depressive symptoms after receiving the naltrexone dose followed by the infusion. The purely mechanistic study was ended early to avoid exposing additional participants to the ineffective combination of naltrexone and ketamine.
It is an exciting time in the study of neurobiological depression research. Understanding the role of the opioid system in the antidepressant effects of ketamine is extremely important to advancing the development of new antidepressant medications. Pursuing the findings from this study may help explain why ketamine’s antidepressant effects are so swift: perhaps a result of the opioid receptor activation in ketamine’s first phase. Further research into ketamine and how it interacts with the brain will provide much needed breakthroughs in the mental health community.
The Difference Between Ketamine & Opiates
The fast acting nature of treatments has made ketamine increasingly popular in treating persistent depression and suicidality in patients. While it is true that some opioids, such as morphine, initially have an antidepressant effect followed by promoting depression with repeated use, this is not the case with ketamine-repeated use leads to increased antidepressant response. The very fact that those in the field of anesthesia, who have been using ketamine since its development in the 1960s, have long regarded it as a nonopioid drug speaks to its unique nature. Dr. Rodriguez called the results of this study “the beginning of a conversation” and said it “highlights that ketamine’s mechanism of action is complicated.” It is likely that ketamine acts through several important neurotransmitter systems affecting mood, anxiety, and the sense of well being.
Is Ketamine Addictive?
Pursuant to the Stanford study, some experts have expressed concern regarding the possibility of patients becoming dependent on ketamine or addicted to it, as is the case with other opioids. While it is true that all risks associated with drug use need to be properly examined, it is important to remember that this study was small and preliminary with results needing to be replicated in future research. Dr. Rodriguez, who has pioneered the use of ketamine as a treatment for OCD, says the study does not prove ketamine works primarily through the brain’s opioid system. Professor Ronald Duman of Yale University has published research demonstrating how ketamine causes brain cells to form new connections. He is not convinced that ketamine’s effect on the opioid system is the key to how it treats depression. Ketamine has a powerful effect on the brain’s glutamate system and “a relatively low affinity for opiate receptors,” says Duman.
Ketamine Efficacy in TRD
Ketamine has proven to be an effective treatment in itself thus far. Nearly 4 million adults in America suffer from treatment-resistant depression. For many, ketamine has been a life saver, literally. The Stanford study opens the door for future studies on ketamine that can provide insight into the underlying neurobiology of depression. However, the study, while intriguing, should not be taken as evidence against the use of ketamine for TRD and suicidality, both of which share a long history of success with ketamine therapy. Under the proper care and supervision of a licensed psychiatrist and medically trained staff, ketamine infusion therapy has treated thousands of patients with outstanding efficacy.
Ketamine Treatment for Depression is Available
At Neuro Wellness Spa, IV ketamine infusions are available for the treatment of acute suicidality, chronic pain, TRD, anxiety, and post-traumatic stress disorder. We offer several locations and extended office hours in a comfortable and relaxing environment to make your visit a pleasure. In addition to ketamine, our offices offer transcranial magnetic stimulation therapy. Call to schedule an appointment with our quality staff where state of the art treatment meets the art of medicine.