Can ketamine infusion therapy work for depression?
What are the advantages?
Ketamine is a medication that has been traditionally used to induce and maintain anesthesia. This drug is often used off-label for conditions such as pain relief, conscious sedation, and depression.
Ketamine has addictive properties and is a popular drug of abuse. The drug is available as white powder, liquid, and tablets and is known as “K”, “Vitamin K”, and “Special K” on the street. Ketamine can cause hallucinations, out-of-body experiences and temporary paralysis. The user may be awake but unable to move or even talk. These effects have led to ketamine being referred to as a “date rape drug.”
In March 2020, SpavatoTM (Esketamine) nasal spray was approved for adults with treatment-resistant depression. This is an important milestone in paving the way for this drug to be used more commonly in depressed and suicidal patients who have tried other treatments without benefit.
Ketamine is not just another antidepressant. It begins to work right away. Other treatments for depression take weeks to work.
The popular selective serotonin reuptake inhibitors (SSRI’s) must be slowly titrated to the effective dose due to side effects. We must be sure the patient can tolerate the drug and wait weeks to determine effectiveness.
The same is true for other antidepressants currently available.
This post will describe the use of ketamine infusion therapy for the treatment of depression.
Suicide
Suicide rates have increased over the past two decades and are one of the top three causes of mortality worldwide for those between the ages of 15-44.1
This has occurred despite efforts to reduce suicide.2
We know that approximately 90% of those who commit suicide suffer from a treatable mood disorder.3
Our current treatment options for those with suicidal ideation consist mostly of hospitalization, psychotherapy, and pharmacotherapy.
Although dialectical behavioral therapy (DBT), cognitive-behavioral therapy (CBT), and treatment with clozapine and lithium have been shown to decrease suicide deaths,4
as well as attempts,7
They take time to work and have not shown effectiveness acutely. This leads us to a search for an antidepressant that can take effect quickly.
Is ketamine a solution?
Ketamine for Suicidal Ideation and Mood Disorders
There have been studies showing that ketamine infusions are effective in treating suicidal ideation and depression in the acute setting. A meta-analysis published in the American Journal of Psychiatry in February 2018 came to the following conclusions:9
- Ketamine significantly reduced suicidal ideation. This occurred within one day and continued for one week after the treatment.
- The change in the severity of depressive symptoms was strongly correlated with the decrease in suicidal ideation.
- Ketamine’s effect on suicidality is only partially due to its antidepressant effects.
- 54.9% of patients had no suicidal ideation 24 hours after a single ketamine infusion, and 60% remained free of suicidal thoughts one week after the infusion.
Are you thinking of Getting a Ketamine Infusion?
If you are considering utilizing ketamine infusions to treat depression or suicidal thoughts, here is what to expect:
- You may receive the infusions as an outpatient or inpatient. Several facilities offer ketamine infusions as an outpatient procedure.
- You may be asked to fill out a questionnaire to determine your depression level before the procedure.
- You will need to arrange for transportation as you will be unable to drive after the infusion.
- The following conditions may exclude you from receiving the ketamine infusion:
- History of schizophrenia, bipolar disorder, or schizoaffective disorder.
- Dementia.
- Delirium within the last seven days.
- Uncontrolled hypertension.
- Pregnancy.
- Certain heart conditions.
- Positive urine drug screen showing substances of abuse or a previous history of substance abuse.
- An allergy or previous adverse reaction to ketamine.
It is important to note that various facilities will have different protocols. Check with your facility of choice to get their specific guidelines. Here is a few typical guidelines used:
- The ketamine infusion will likely last about 40 minutes.
- Vital signs (heart rate, blood pressure, oxygen blood levels, etc) will be monitored during the infusion.
- As with any medication, you may experience side effects. Some of these include:
- Confusion
- Delirium
- Dream-like state
- Excitement
- Hallucinations
- Irrational behavior
- Vivid Imagery
- Change in heart rate
- Change in blood pressure
- Seizure-like movements
- Rash
- Nausea and vomiting
- Double vision
- Others
Ketamine infusions will normally be given on a pre-determined schedule. A typical schedule may be:
- Twice a week for 2-3 weeks (not less than three days apart)
- After 2-3 weeks, the infusions should be weekly to every three weeks with a goal to extend the infusions to an interval if possible. This will vary based on patient response.
- Ketamine infusions should be tapered when discontinued.
- Ketamine infusions range from $400-$800 per infusion, and there may also be an initial consultation fee. These prices are for outpatient procedures. It is important to note that most health insurance plans do not cover these infusions. Inpatient treatment can cost substantially more.
I am a huge proponent of using ketamine infusions for treatment-resistant depression. I have spent many years caring for psychiatric patients, and some do not respond to conventional therapies.
Depression is a devastating mood disorder that can rob an individual of a fulfilling life. It can ruin careers, relationships, and even result in death.
If you have any thoughts of ending your life or are depressed, GET HELP. Call someone! There are many resources available to help you. You can get better. We can help!
The Suicide Hotline can be reached at:
800-273-8255
With the recent approval of SpavatoTM, my hope is that some of the stigma associated with ketamine will dissipate. Many drugs we use every day have the potential of being abused. The fact is ketamine can help some of our most vulnerable people.
As a society, we have the responsibility to care for our sick individuals. This includes those with mental disorders. Anyone can become depressed! I pray that we will embrace the potential of ketamine infusions. After other treatments have failed, those who need ketamine should have access to it.
Insurance companies should pay for it!
It is more costly to hospitalize someone for weeks while our traditional treatments take effect. One of ketamine’s most important benefits is that it begins to work right away. This can be the difference between life and death!
Ketamine is a subject I have wanted to write about for some time. We are unable to use ketamine infusions in our facility due to a perceived danger. It is possible to refer those patients who might benefit from ketamine to an alternative facility. I plan to continue to lobby for its use within our facility. I believe we owe it to our patients.
If you have any questions about ketamine or any other medication, health issue, or nutraceutical, please contact me.
I am happy to help whenever I can. That is why I started Sunshine Nutraceuticals in the first place.
Have a great week, everyone, and stay safe!!
Michael J. Brown, RPh, BCPS, BCPP
Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.
Feel free to send Michael a message using this link.
Disclosure: This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.
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- Wilkinson ST, Ballard ED, Bloch MH, et al. The Effect of a Single Dose of Intravenous Ketamine on Suicidal Ideation: A Systematic Review and Individual Participant Data Meta-Analysis. Am J Psychiatry. 2018;175(2):150-158. doi:10.1176/appi.ajp.2017.17040472
