Ketamine is not a new phenomenon, although it seems to be in the news a lot these days as if it was recently discovered. As a medication traditionally used as an anesthetic, ketamine now shines as a potential lifesaver for those struggling with severe depression, anxiety, and suicidal tendencies. As an anesthesiologist, I provide all types of anesthesia, from simple to complex cases, but I am particularly focused on using the best evidence-based medicine to provide interventional mental health services. Through the practice I founded in Houston, Texas, Well Medicinemy colleagues and I provide treatments such as ketamine infusions, stellate ganglion blocks, and nitrous oxide treatments for mood disorders.
Ketamine: then and now
Ketamine was developed in the early 1960s and was long known as an anesthetic used in veterinary medicine. While it has a reputation for being strong and dangerous, which it can be if not used clinically, ketamine is a world-renowned and widely used drug that is safe and effective in a controlled, professional medical environment. It has been administered countless times under rigorous circumstances and to the sickest and most fragile patients.
New research and evolving clinical use keep this ancient drug in the headlines of research publications and newspapers around the world. About 8 percent of American adults report a major depressive episode, while 18 percent of American adults suffer from anxiety symptoms and suicide was the 11th leading cause of death in 2021.
With rising rates of depression and anxiety, we are seeing a pattern that shows no signs of abating, and as an ADAA member and mental health medical professional, I am very concerned. Like any medication, therapy or drug treatment, ketamine has its side effects and disadvantages, but we need to look at the benefits and evidence-based scientific information that shows that using ketamine is safe, effective and often produces a immediate improvement.
Ketamine and depression
Ketamine remains an excellent treatment option for major depression, and more than 70 percent of patients saw a significant reduction in negative symptoms with three infusions. In fact, results from a single ketamine infusion can show benefits within an hour and last up to 14 days. Infusions are recommended as part of a series tailored to the patient’s needs. Outside of clinical research studies, some type of therapy is often added to help build resilience and coping strategies during the series of ketamine infusions. Ketamine’s extensive interactions with receptors and its good safety profile make it a promising alternative for patients who do not respond to standard treatments.
Ketamine and anxiety
New studies show that ketamine is effective in refractory treatment (treatment resistant) anxietyeven in a population that has both refractory anxiety and treatment-resistant depression, which is generally considered a more difficult population to treat due to more severe symptoms and greater likelihood of relapse.
Treatment-resistant anxiety causes damage to neural connections in the hippocampus and prefrontal cortex. Part of the downstream effects of ketamine binding to its various associated receptors is to increase neuronal plasticity and growth, which may help reverse some of the changes in the hippocampus and prefrontal cortex. In other words, if persistent anxiety that resists treatment is not addressed, it can cause more long-term damage.
The impact of ketamine on suicide
Recent studies have demonstrated the ability of ketamine to rapidly reduce symptoms of suicide. Notably, 78 percent of patients who experienced suicidal thoughts showed gradual or rapid improvement after treatment with intravenous (IV) ketamine, positioning it as a critical component in the suicide management toolkit.
Future research and promise
The link between biological markers and response to ketamine treatment is an area ripe for exploration. Future studies are encouraged to investigate how specific endophenotypes, genotypes, response patterns, and biomarkers could inform treatment plans, particularly as they relate to suicide prevention, the timing of relapse prevention, and maintenance programs for maintain antisuicidal effects.
Ketamine has been a breakthrough treatment for anxiety, depression, and suicidality. Its ability to provide quick and effective relief in treatment-resistant cases offers hope to those struggling with serious mental health issues. As research evolves, ketamine remains an indispensable tool in our mental health treatment arsenal. I hope that ketamine continues to be seriously considered by healthcare providers, patients, and families exploring treatment options. It has the potential to illuminate so many people in the darkness.
For copies of the posters presented at the ADAA 2024 annual conference in Boston, Click here.
