What Is Ketamine? How It Can Help with Severe Depression?

Ketamine isn’t a new medication—it’s been used as an anesthetic and recreational drug—and has gained attention recently as a potent, rapid treatment for depression. 

On its face, this is welcome news for the 19.4 million adults in America who have had a major depressive episode. However, it’s critical to understand what ketamine treatment is and its potential effects before deciding if this therapy is right for you. Learn more about what ketamine is used for, how it works, and potential side effects. 

What Is Ketamine?

Ketamine is a medication classified as a “dissociative anesthetic.” It sedates and calms users, and it also separates them (or dissociates them) from feelings of pain. That’s why it’s been employed for short-term anesthesia. Further, it’s also known as a potent club drug with street names such as Special K or Cat Valium. 

There are two types of ketamine mental health treatments: racemic ketamine IV infusions and esketamine nasal sprays.

Racemic Ketamine

As an anesthetic, racemic ketamine is approved by the U.S. Food and Drug Administration, but its use as a depression treatment is off-label. This version of ketamine is administered with an intravenous (IV) infusion. 

How Does a Ketamine Infusion Work?

IV treatments infuse the fluid in the IV drip bag through a tube inserted into the patient’s arm. The ketamine goes into the bloodstream, which allows for maximum absorption and effects that can occur almost immediately. Infusions are usually administered over a period of several weeks.

Esketamine

This form of ketamine is taken via nasal spray under the direction and supervision of a medical professional. It was approved by the FDA for depression treatment in 2019 and is manufactured under the brand name Spravato®. Because it is inhaled, esketamine takes effect differently than racemic ketamine that enters the body via the bloodstream. Esketamine can take effect fairly quickly where dosage can be individualized according to a patient’s needs. 

Both types of ketamine are used in lower doses than the anesthetic version of the medication. Because they work differently inside the body, and because esketamine is a relatively new treatment, it is difficult to compare the two.

How Does Ketamine Work for Depression?

Scientific research hasn’t narrowed down a particular reason why ketamine works for depression. It’s thought that the medication acts on the glutamate system, which is a widespread neurotransmitter system that affects mood. It’s thought that the medication increases the amount of glutamate, a neurotransmitter in the brain that influences mood.

Ketamine may also improve communication between neurotransmitters in the brain and lower inflammation, which can also impact mood. Because esketamine was only recently approved for use with depression, it's an area that's still being researched. 

What is Ketamine for Depression Used For?

Ketamine is noted for the quick effect it can have on symptoms of major depression. Patients may experience rapid reduction of depression symptoms, including suicidal thoughts. 

Both types of ketamine for depression should be used for people who haven’t responded to other first-line antidepressant medications and have treatment-resistant depression. While some clinics may advertise that they use ketamine for other mental health conditions, such as bipolar disorder, obsessive compulsive disorder (OCD), and co-occurring depression and anxiety. However, these uses are off-label and haven’t been cleared by the FDA. 

While it will be interesting to see how ketamine works over the long term, it’s crucial to note that it isn’t a wonder drug. It’s thought that a patient also needs talk therapy in conjunction with ketamine treatment to be most effective. Some potential side effects are associated with ketamine treatment. The short-term effects include:

• High blood pressure
• Nausea
• Vomiting

Not everyone who uses esketamine will experience these side effects, and in affected individuals, these issues tend to resolve within an hour or so.

Other points to remember:

• Ketamine’s dissociative properties can result in temporary euphoria, altered mood, and an out-of-body sensation.
• Ketamine can be addictive, which can pose a potential risk for patients who have depression and a co-occurring substance use disorder, which is why it’s well-regulated by the FDA and is offered only in an outpatient setting. 
• Because ketamine is a newer depression treatment, its long-term effects aren't known.

If you are concerned about the potential side effects and risks of ketamine, you may also want to consider TMS for depression treatment if your first line treatment options, including antidepressants and talk therapy, haven’t delivered the desired results. 

TMS has proven effectiveness at alleviating depression symptoms—without the use of sedatives or invasive therapies and with minimal side effects. And unlike ketamine, TMS is cleared for OCD and anxiety symptoms related to depression. With TMS, an electromagnetic coil placed on the scalp sends magnetic pulses to stimulate targeted areas of the brain. TMS is designed to alleviate symptoms over the course of several weeks of treatment.

Contact us to learn more about esketamine nasal spray or TMS treatment as an option for depression treatment.