More than 16 million American adults each year are affected by major depression. antidepressants and other traditional treatments are not effective for almost a third of the patients. Untreated depression increases the chance of alcohol and drug dependence, as well as suicide.

Massachusetts Psychiatric Services offers a treatment that might be useful for people who don’t have other depression treatment options. The most recent research on ketamine demonstrated that the drug works quickly, Keamine is administered by the team after a thorough psychiatric evaluation and medical clearance. The administration is under the supervision of an anesthesiologist.

  • makes dramatic improvements in mood, and can work on people who haven’t gotten better with other depression treatments.
  • Though the success rate is high, some patients may not respond to this treatment.

What is Ketamine?

Ketamine is an anesthetic drug that blocks pain, developed in the 1960s and was used to operate on soldiers during the Vietnam War. It has also been used as an animal tranquilizer.

Researchers started studying ketamine as a treatment for depression in 2000. Over the years, their research showed that it improves mood much faster than traditional antidepressant drugs, and it works when some of these drugs have failed.

Ketamine is FDA-approved as an anesthetic for surgery and diagnostic procedures. It’s also used to treat depression, suicidal thoughts.

How does it work?

It is still unclear how Ketamine works to treat depression. Unlike antidepressants, which work by shifting the balance of brain chemicals, ketamine is thought to change the way brain cells communicate with each other.

Recent studies find that ketamine can have long-lasting effects on depression, even though the drug only stays in the body a short time.

Ketamine starts working within a few hours unlike antidepressants, which can take weeks or longer to take effect. This rapid effect can be lifesaving for people who are suicidal. Ketamine can also help people who haven’t found relief from other depression treatments.

How is it given?

Usually, ketamine is given as an IV into a vein, which is the quickest route for the medicine to get to the brain. Based on the psychiatrists’ assessment, the recommendations for the number of treatments can differ.  Most people start with about six doses over a period of 1 to 2 weeks, and then get booster IVs doses once every 3 to 5 weeks.

What are the side effects?

Right after getting the drug, people often experience “dissociative” side effects, which is kind of like having an out-of-body experience. Colors might look blurred, or you can have the sensation that you’re looking down at your body. The feeling lasts for about an hour after the IV, and then it should wear off, while the drug’s benefits continue. THE DOCTOR CAN GIVE MEDICINES TO ADDRESS THESE EFFECTS AS IS NECESSARY. The anesthesiologist is closely monitoring you during the treatment and will intervene as needed to address dissociative states or changes with BP and heart rate.

The drug can also cause a spike in blood pressure and heart rate in the short term and could be riskier for people with heart disease. A THOROUGH MEDICAL CLEARANCE IS DONE PRIOR TO STARTING THESE TREATMENTS.

Inclusion Criteria

  • Age 18-65 yrs.
  • Major Depressive Disorder or Bipolar Disorder I or Bipolar Disorder II with Patient Health Questionnaire-9 (PHQ 9) score ≥15 at initial assessment
  • Treatment resistant depression (TRD) as defined by at least two previous antidepressant or mood stabilizing treatments for depression in adequate dose for 8 weeks
  • Patients with demonstrated insufficient response to ≥2 adequate antidepressant trials in the current episode.

Exclusion Criteria

  • Diagnosis of schizophrenia, schizoaffective disorder, or active psychosis
  • Previous use or abuse of methamphetamine, cocaine, stimulants (prescribed and illicit) within past 12 months
  • Any current abuse or dependence of alcohol or drugs (except nicotine) and abuse or dependence of drugs and alcohol
  • History of traumatic brain injury
  • Developmental delay and intellectual disorder
  • Pregnancy

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