Ketamine is not an FDA approved treatment for major depression and is considered investigational only. However, the safety and efficiency of Ketamine as a short infusion for the treatment of Major Depression has been established in medical literature.
Ketamine is an anesthetic agent that has a mechanism of action different from all other anesthetics. Ketamine influences the glutamatergic system of the brain. This part of the brain has been implicated in depression and in chronic pain. Medical literature suggests that ketamine could be useful in the treatment of major depression. In various clinical studies, ketamine has shown a strong, fast and persistent antidepressant effect.
Is Ketamine the right option for you?
Ketamine is not approved by FDA for the treatment of depression.
The clinical studies suggest an improvement of depression in patients with resistant major depression in 25-80% of the cases at 24 hours after the treatment and 15-75% of the cases at 72 hours after the treatment. For now, there is no way to predict if a patient will or will not react positively to ketamine.
How is it done?
It is a slow intravenous infusion of a subanesthetic dose (smaller than the dose needed for general anesthesia). An intravenous line will be placed and you will be monitored throughout the infusion and for a while afterwards. The duration of the infusion will be approximately 40 minutes, and you will need to stay in the office for up to 2-4 hours after the infusion ends.
You are not allowed to drive yourself home. A responsible adult needs to pick you from the office and drive you home. You are not allowed to leave the house by yourself on that day. If you live very far from our office and need a very long drive home, we might do the procedure only on condition that you stay overnight in a nearby hotel.
A recently published paper in the American Journal of Psychiatry (epub- ahead of print) suggests a 10% improvement rate after the first infusion, and a 70% improvement rate with repeated infusions ( it is more likely that you will respond to Ketamine if you receive repeated doses, rather than after one single dose). The regimen suggested by the article involves 2-3 weekly infusions for a 4-week period.
What are the side effects?
Side effects noticed were mild and they did not outlast the duration of the antidepressant effect. Since the amount of ketamine infused is very low, much smaller then the amount needed for anesthesia, most side effects disappear within 80 minutes from the infusion time. Possible side effects from ketamine include bad dreams, nausea or vomiting, brief changes in blood pressure or respiration, dizziness, fatigue, or increased salivation.
Are there any additional benefits?
In patients with cancer and major depression, there can be a partial improvement of the pain level as well.
What is the cost?
Ketamine is considered investigational by both FDA and the insurance companies. All the cost related to Ketamine treatment is out of pocket.
- A single dose of Ketamine is as effective in 24 hours as conventional antidepressants after many weeks of use.
- Ketamine is effective in both unipolar and bipolar depression
- Rapidly acts against suicidal ideation
- A single dose of ketamine is usually effective for 2 weeks
- Ketamine can be especially effective where depression accompanies chronic pain
- It is considered investigational by the FDA
- It is not covered by insurance
- It has a small but not zero potential for dependence
- It is not effective in everyone: there is a 30% chance that Ketamine would not be effective in a patient, even with repeated doses
- So far chronic Ketamine treatments have not been adequately investigated from the point of view of potential side effects and efficiency