Ketamine for Depression

More than 20 million Americans struggle with ongoing depression, a mental illness that severely impacts their ability to function well. Chronic depression not only damages the sufferer’s quality of life, but it can also increase their risk of suicidal thoughts or actions.

It’s important to distinguish between occasional negative mood fluctuations that come and go and major depression, characterized by persistent sadness and hopelessness that lasts for two or more weeks. Major depression, also called clinical depression, is a diagnosable mental disorder.

For decades, doctors have prescribed medication and psychotherapy to treat depression. However, a recent study published in the Journal of Clinical Psychology finds that almost 31 percent of those suffering from major depressive disorder have treatment-resistant depression (TRD). TRD means symptoms don't improve, or they improve temporarily and then recur after trying multiple antidepressant medications. This is where the potential of ketamine treatment comes in.

The depression research field is buzzing over the results of numerous studies suggesting the efficacy of low-dose ketamine in treating depression and can even be effective for treatment-resistant depression (TRD). Our own patient outcome data also supports the efficacy of our treatment program for patients with moderate and severe depression, helping thousands of patients reach depression scores (PHQ) in the mild/non-clinical ranges.

To understand more about why low-dose ketamine may be an excellent alternative for treating depression, it helps to understand the disease of depression – the different types of depression and their symptoms, the dangers of untreated depression, how traditional antidepressant medications differ from low-dose ketamine, and how ketamine can improve the psychotherapeutic process.

Types of Depression and Common Symptoms

Those with major depressive disorder often have relentless feelings of sadness, guilt, loss, and hopelessness. Depression affects how individuals feel, think, and respond to people, events, and activities around them and often robs them of the ability to function well at home, work, or school. People who struggle with depression may find it difficult to accomplish day-to-day responsibilities.

The most current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides doctors with diagnostic guidelines for various mental illnesses, including major depressive disorders. According to the National Institute of Mental Health, the DSM-5 recognizes and addresses the following types of depression:

• Major depression – may include feeling sad, nervous, hopeless, or worthless, constant fatigue, crying easily and often, eating too much or too little, not being interested in activities once enjoyed, and having frequent thoughts about death and suicide.
• Persistent depressive disorder (also called dysthymia) - symptoms are similar to major depression but less severe. However, symptoms last much longer, often for at least two years.
• Perinatal or postpartum depression – when a woman suffers major depression symptoms during pregnancy (perinatal) or after delivery (postpartum).
• Seasonal affective disorder – symptoms of major depression occur seasonally, usually beginning in late fall or early winter and lasting until spring or summer.
• Depression with symptoms of psychosis – signs of a depressive disorder accompanied by symptoms of psychosis which may include delusions or hallucinations.
• Disruptive mood dysregulation disorder – applies to children and adolescents with major depressive symptoms.
• Premenstrual dysphoric disorder – severe premenstrual syndrome with symptoms of major depression.

To meet the diagnostic criteria for a major depressive disorder, individuals must experience persistent symptoms for at least two weeks. See the full DSM-5 diagnostic criteria for Major Depressive Disorder (MDD). A doctor may diagnose MDD if the patient experiences five or more symptoms nearly every day during a 2-wk period.

Untreated depression can harm every aspect of the struggling person’s life. Besides damage to their physical and mental health, depression can destroy valued relationships, cause social isolation, create conflict at work or school, lead to self-harm and substance abuse, and increase the risk of suicidal ideation. According to the CDC, one person dies by suicide every 11 minutes in the United States. Many suicide victims struggled with depression.

It's essential that those suffering from depression reach out for help. Even those who experience few or occasional symptoms can benefit from treatment. And if antidepressants don't work, low-dose ketamine may be the answer.

Antidepressants vs. Low-Dose Ketamine – How Do They Work?

While researchers don’t have a definitive answer as to how antidepressants work, many believe the drugs target neurotransmitters in the brain. Neurotransmitters are chemicals like serotonin, dopamine, and norepinephrine that carry signals to other cells to regulate various physical and mental functions.

Scientists have long recognized the relationship between serotonin, norepinephrine, and other chemicals and mood, sleep, behavior, pain receptors, and memory. Studies suggest that many people experience a lessening of depressive symptoms when levels of these chemicals are higher. Because of this, pharmaceutical companies formulate antidepressants to boost levels of serotonin and other specific neurotransmitters, seeking to relieve symptoms related to depression, anxiety, PTSD, OCD, and chronic pain.

Unfortunately, many patients have experienced downsides to traditional antidepressants including:

• They can take two to six weeks or longer to become effective. If the individual does not experience improved symptoms after six weeks, that medication may not be appropriate for them.
• They may cause uncomfortable side effects. Side effects can vary depending on the antidepressant used but may include nausea, agitation, diarrhea or constipation, poor sleep, dizziness, sexual dysfunction, and more.
• They are only effective for some.

The effects of an antidepressant can vary for each person. If one is causing uncomfortable side effects, the doctor may suggest a different antidepressant. If the doctor and patient determine the antidepressant isn’t working or is no longer needed, the doctor will help wean the patient from the drug. Stopping an antidepressant "cold turkey" can cause uncomfortable, possibly severe, side effects, including worsening depression and insomnia, flu-like symptoms, headaches, pain, thoughts of suicide, and more.

So, how does low-dose ketamine differ from traditional anti-depression medications? One significant difference is that ketamine rapidly interacts with glutamate, a brain chemical that plays a vital role in mood regulation. Research suggests that it's the effect of ketamine on glutamate levels that enable the brain to repair neural connections previously damaged by long-term stress, depression, and anxiety and even form new neural pathways.

Because ketamine acts so quickly upon glutamate receptors, individuals can experience relief of depressive symptoms very fast, sometimes within two hours. Obviously, this timeline is vastly different from the two to six weeks an individual may have to wait before antidepressants become effective.

Numerous studies have zeroed in on ketamine’s effect on glutamate as the likely reason the drug is effective in relieving symptoms of major depression. A study entitled The promise of ketamine for treatment-resistant depression: current evidence and future directions concluded that drugs like ketamine that target the glutamate system hold high promise as a novel, efficacious, and rapidly acting treatments for MDD [major depressive disorder].” But there may be more to the story.

New findings by scientists at the Stanford School of Medicine reveal ketamine may also activate the brain’s opioid receptors, helping alleviate symptoms of depression and physical pain. Although doctors have prescribed opioids for decades, primarily for pain relief, the medications carry a high risk for abuse and addiction. Ketamine does not carry these same risks.

The Stanford findings, published in the American Journal of Psychiatry, may be the first to demonstrate how ketamine actually works to relieve depression – by interacting with both glutamate receptors and opioid receptors. Alan Schatzberg, M.D., one of the study authors, stated, “Before we did the study, I wasn’t sure that ketamine really worked to treat depression. Now I know the drug works, but it doesn’t work like everyone thought it was working.

If you're on a prescribed antidepressant and want to continue, it's important to note that taking a traditional antidepressant and low-dose ketamine simultaneously is not contraindicated. Many patients choose to take both and have not reported problems while on our treatment plan.

How Can Ketamine Improve Your Healing Journey?

If you are struggling with depression, your doctor or mental health professional will likely recommend a combination of antidepressants and psychotherapy, also known as “talk therapy.” And while this may work for some, the reality is that antidepressants carry risks and are not effective for everyone, and traditional talk therapy can take years before you achieve much progress.

However, there is a combination of medication and talk therapy that may be right for you – taking very low-dose ketamine while working with a trained practitioner.

High doses of ketamine can cause psychedelic effects. Therapeutic doses are much lower, and although they do not trigger a hallucinogenic reaction, they can open the mind in fascinating ways. Because of the way ketamine affects the mind, it may help you accomplish your healing goals much more quickly.

Unlike the intense effects of a psychedelic journey, low-dose ketamine therapy promotes a calm inner and outer environment where you can focus on self-examination and change. You remain lucid but detached, allowing you to examine your thoughts and emotions without being overtaken by them. Working with a therapist in this gently altered, more positive state of mind. You can explore the root causes of your depression together with a mind open to inner changes and new possibilities for your future.

At Joyous, our mission is to help lift our patients from the overwhelming pain of depression so they can live bright, positive lives. Our very low-dose ketamine protocol has helped thousands heal. Contact us today to see how Joyous can help you.