The Promising Potential of Ketamine

December 11, 2018

Depression is a common mental disorder, affecting roughly 1 in 20 (16 million) Americans, and over 300 million people worldwide. The World Health Organization names depression as the leading cause of disability globally. Depression can often be successfully treated through psychological therapy (e.g., cognitive behavioral therapy, behavioral activation, psychotherapy), pharmacotherapy (e.g., selective serotonin reuptake inhibitors (SSRIs)), and psychosocial treatment. But for some people, depression does not respond to these treatments, or side effects of medications may become intolerable. Ketamine, a compound initially used as an anesthetic, holds exciting promise as a newer alternative to more traditional treatment approaches. One of the pioneers in the research on ketamine’s beneficial effects for those with treatment-resistant depression, Columbia Psychiatry now offers comprehensive ketamine treatment for eligible adults at ColumbiaDoctors Midtown.

Through the Columbia Ketamine Program, J. John Mann, MD, Professor of Translational Neuroscience (in Psychiatry and in Radiology) and Vice Chair for Research in the Department of Psychiatry at Columbia University, Joshua Berman, MD, PhD, Assistant Professor of Psychiatry at Columbia University Irving Medical Center, and other physicians are making their expertise available to patients with depression who seek ketamine treatment. Beginning with a thorough evaluation that includes a medical history and lab tests, Dr. Mann, and his colleagues assess whether ketamine would be an appropriate treatment. For adults 18 and older who qualify, infusions of ketamine are given for two weeks, with follow-up infusions as recommended by the psychiatrist. Generally, treatment consists of 8-12 infusions over a 4-6 week period.

As Michael Grunebaum, M.D., Associate Professor of Psychiatry at Columbia University Irving Medical Center and a Research Psychiatrist at the New York State Psychiatric Institute, explains, “Ketamine, a drug that alters the brain chemical glutamate, was first approved in 1970 for use in anesthesia. Its antidepressant effects – at much lower doses than used for anesthesia – were first discovered around 1980.” In contrast to the commonly prescribed SSRIs, whose antidepressant effects generally take weeks to kick in, ketamine’s impact is fast-acting. “The latest research,” Dr. Grunebaum says, “suggests that ketamine markedly reduces depression symptoms (by at least 50%), including suicidal thoughts, in a few hours in about half of those who receive one treatment.” This easing of depressive symptoms from one treatment session—during which a patient is given an infusion of ketamine intravenously—lasts about a week. While the underlying mechanism is not yet known, Dr. Grunebaum says that “current research suggests it may involve enhancement of nerve cell connections in key brain areas involved in depression.”   

Given that depression often first appears at relatively young ages and that it tends to be a chronic condition requiring long-term treatment, Dr. Grunebaum notes “that individuals with depression may face decades of the problematic side effects from currently available medications—which act primarily on serotonin and norepinephrine.” These unpleasant reactions can include “GI symptoms, profuse sweating, sleep disturbance, and sexual dysfunction,” says Dr. Grunebaum. “Ketamine,” on the other hand, “appears to act through different chemical pathways in the brain, which has led to excitement about the potential for development of a new class of antidepressants that work more quickly and have fewer side effects.” There is evidence that ketamine is effective in treating individuals whose depression has not adequately responded to existing treatments, those with “treatment-resistant depression," which includes “from one third to one half of patients” with depression, Dr. Grunebaum observes.

When asked about potential drawbacks of ketamine treatment, Dr. Grunebaum explains that it can produce “spacey ‘dissociative’ feelings, blood pressure elevation (usually modest), and sometimes nausea or anxiety, during the treatment session.” “However,” he says, “these side effects generally disappear within an hour or so after the treatment is received.” Other limitations include the short – “approximately one-week” – duration of its antidepressant effect following a treatment session. Dr. Grunebaum also cites our limited knowledge of long-term safety and effectiveness (“e.g., beyond 8-12 treatments over a month or so”), and he emphasizes ketamine’s abuse potential, noting that “there is evidence from addiction studies that long-term, heavy ketamine use can cause serious brain damage. Thus, research on longer-term use of ketamine for depression and the development of safer, alternative medications is essential.”

Dr. Mann points to specific work that corroborates findings from early studies in the field: “Columbia researchers have carried out two large-scale NIH-funded studies that have found ketamine to have both antidepressant and anti-suicidal benefits.” Again, as Dr. Mann reports, the desired effect of the drug is rapid when it occurs: “Significant benefits appear in 24 hours after a single dose of ketamine, although like any treatment there is no guarantee of a good response.”

To see if ketamine treatment is appropriate for you or someone you know with depression, call 212-305-6001 to speak with an intake specialist and to schedule a 90-minute evaluation with a psychiatrist who has expertise in treatment-resistant depression. Consultation, treatment, and follow-up care are all offered in the safe and convenient ColumbiaDoctors Midtown location at 51 West 51st Street.

Topics

Mental Health, Depression, Psychiatry

Tags

Ketamine