Why do psychiatrists prescribe Ketamine for the treatment of depression and anxiety?
It’s an interesting question. And, for potential patients and referring clinicians, it is an important question to understand. In short, there are two good answers:
One, it works fast. And two, it can work for people for whom traditional treatments don’t work.
Now, let’s unpack these answers a little more:
When the antidepressant quality of ketamine was first investigated back in the early 1990’s one of the first things physicians and researchers took note of was how quickly patients saw improvements. Over the course of the past two decades, it has become increasingly clear that ketamine operates at an unparalleled therapeutic rate. Patients infused with intravenous (IV) ketamine often experience near instantaneous relief from depressive symptoms, demonstrating clinically significant responses after only a single 40-minute infusion session.
Take a moment now to compare this response time to traditional antidepressant medications, including SSRI’s and monoamines. These drugs, while effective for some, generally take weeks to months to take effect. Even on these treatment regimens, patients can be left struggling aimlessly. And, for people with severe or highly acute cases, this delay in response may have serious, even life-threatening, consequences.
For this reason, Dr. Carlos Zarate, Chief of Experimental Therapeutics at the National Institute of Mental Health, calls IV-ketamine treatment a “paradigm shift” for the field of psychiatry. For one he explains, the rapidness of IV ketamine has the potential to treat and save innumerable individuals suffering from suicidal ideations. Fundamentally, ketamine can stabilize individuals—allowing them to survive long enough to seek further treatment.
He also explains that the rapidness of the response allows for clinicians to quickly correct and respond in cases where ketamine may be ineffective. In other words, if a patient does not respond after the first or second therapy, treatment can be stopped—there is no need to wait months or weeks for a potential response. Long term, this aspect of ketamine delivery will save both time and resources for patients and physicians.
Effective in Treatment-Resistant Patients
Since the advent of traditional antidepressants in the early 1950’s, depression has typically been treated with a combination of counseling and prescription drugs. Use of traditional antidepressants (particularly SSRI’s) has continued to increase in recent years, to the point that nearly 1 in 10 Americans is on an antidepressant medication. However, as commonplace as these drugs are, they are anything but perfect. In fact, statistically, these drugs only have a positive remission response rate of 30-50%, meaning that traditional antidepressants are simply ineffective for half of the patients seeking treatment.
Patients who have tried and subsequently failed one or more drug trials are described to have treatment-resistant depression. For these individuals, seeking relief from symptoms can be a seemingly bleak endeavor, lasting years.
It is in cases like this that ketamine may be an appropriate intervention, as ketamine has repeatedly proven to be effective when traditional interventions are not. In part, this novel efficacy is due to ketamine’s unique biochemical mechanism. Unlike traditional antidepressants, ketamine does not target neurotransmitters like serotonin, norepinephrine or dopamine. Instead, researchers now believe that ketamine stimulates a broad set of receptors in the brain, which in turn facilitates a process called synaptic neuroplasticity. This process allows the brain to grow and change and is directly linked to the improvement of depressive symptoms.
Recently, in one of the largest IV-ketamine studies to date, Dr. Cristina Cusin at Massachusetts General Hospital found that between 60-70% of patients with treatment-resistant depression responded positively to IV ketamine infusion. Keep in mind, these were all individuals who had failed to see symptom improvement from any previous psychiatric intervention!
In this way, Ketamine is not a first line of defense. But instead, it is an invaluable tool for psychiatrists to have at their disposable in order to treat the full range of clinically-unique individuals. At KetaWellness, we recognize the potential this therapy has an aim to provide this treatment to those who need it most. Our team of trained clinicians and technicians offer a safe and comfortable experience, and we work with both the patient and the referring clinician to determine if IV Ketamine Therapy is the most appropriate treatment. If you believe that you or one of your patients could benefit from IV-ketamine therapy, please contact us for a consultation.
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