Can Ketamine Treatments Cure my Depression?

Recent discoveries suggest Ketamine is effective in treating depression, but should only be administered by a health professional. Self-administration of ketamine can be deadly. Ketamine therapy involves small doses of the drug, either through an infusion or a nasal spray. Studies on ketamine have shown it to be both fast-acting and beneficial in treating depression, especially when other treatments have been exhausted and proven unsuccessful.

What is Ketamine?

Ketamine is an FDA-approved drug for anesthetic purposes. It can be used to treat a variety of conditions, including narcolepsy, sleep apnea, and migraines. It is also used for acute and chronic pain management.

In 2019, the FDA approved a derivative of ketamine, esketamine, for patients with treatment-resistant depression. Since then, researchers have been looking into the anti-depressive and anti-suicidal effects of ketamine.

A National Institute of Health (NIH) sponsored research paper lists some common uses for ketamine:

• General Anesthesia
• Severe anxiety disorders
• Severe bipolar disorder
• Drug addiction rehabilitation
• Neuropathic pain
• Cancer pain syndromes
• Phantom limb pain
• Severe depression
• Suicidal ideation
• Severe PTSD

Ketamine and Depression

Ketamine is used to treat treatment-resistant depression (TRD). One NIH publication defines TRD as an “inadequate response to at least one antidepressant trial of adequate doses and duration.” TRD means that the medication you were prescribed for treating your depression is not working for you. It is estimated that at least 30% of all major depressive disorders are treatment-resistant. 

Ketamine can be clinically administered for TRD in a safe and controlled way via nasal spray or intravenously (IV infusion). Ketamine therapy can include one or more in-clinic ketamine dosing sessions under clinician supervision and additional therapy techniques (e.g., CBT). If you have been prescribed ketamine therapy, you must have the treatment administered by a healthcare professional in a clinic.

Is Ketamine Legal?

Ketamine has been FDA-approved since 1970 for use as an anesthetic. Its antidepressant properties were not discovered until later, so right now, ketamine is legal but "off-label" to use in depression treatment. The term "off-label" refers to administering an FDA-approved drug for a therapy that it has not yet been approved for. 

For example, the medication Gabapentin has FDA approval for treating seizures but has a growing laundry list of conditions it is commonly prescribed for such as migraines. Off-label prescribing is a legal practice, however, the safety and efficacy have not been reviewed by the FDA. 

Side Effects of Ketamine

Side effects associated with ketamine include anxiety, hallucinations, and seizure disorders among many others. Dr. Nima Fahimian, a psychiatrist who specializes in ketamine-assisted therapy, states that “higher doses, which are not used to treat depression, can present side effects such as sedation, confusion, feelings of detachment, intense hallucinations, changes in heart rate, slowed breathing, impaired motor function, and more.” 

Potential Side Effects of Ketamine

Source: American Addiction Centers

Forms of Ketamine

There are two main types of ketamine used to treat TRD: Racemic Ketamine and Esketamine (brand name Spravato).

Esketamine (Spravato) is closely related to ketamine and is taken with other antidepressants, or alongside other therapy practices. Studies have shown that both forms are effective in treating depression, but not enough research has been conducted to place one ketamine treatment type above the other. You and your healthcare provider will decide how long you will receive infusions or use Spravato based on your response to the medication.

The relief you can find from a single infusion can last for quite some time, ranging from a few hours to a few days. After multiple sessions of infusions or nasal sprays, most patients will require "maintenance" infusions on an ongoing basis to maintain the positive effects of ketamine. When IV ketamine therapy works, Harvard Medical School states that people "usually respond to it within one to three infusions. If a person has no response, further infusions are unlikely to help. Instead, it's probably best to try other treatments for depression."

Treatment Process

Dr. Sanacora, a professor of Psychiatry at Yale University and the Director of the Yale Depression Research Program, also believes ketamine is only one small part of treatment and advocates for comprehensive treatment plans for depression going beyond just ketamine therapy. Other doctors alike agree and advocate for psychotherapy to be coupled with ketamine infusions. 

Ketamine helps break through patients' psychological obstacles that may hinder psychotherapy. Dr. Nima Fahimian described ketamine as a tool to help therapists work around these obstacles and find improvements more readily. This drug has been extremely useful in depression treatment. Its speed as depressive symptoms often improve within hours of ketamine treatment. Additionally, research has shown that some patients can experience responses from single and multiple doses of ketamine for weeks to months.

Ketamine therapy is only considered after you experience failure of standard treatment. Once prescribed ketamine, you will be monitored upon administration of the drug, whether it be intravenously or through the esketamine nasal spray. You must be prescribed ketamine therapy by a professional health care provider. Some exclusionary criteria provided by the American Psychiatric Nurses Association (APNA) include anyone who has:

• Active substance abuse
• Negative urine toxicology screening prior to the initiation of treatment
• History of psychosis
• History of increased intracranial pressure
• Pregnancy (current)
• Uncontrolled hypertension
• Acute or unstable cardiovascular disease
• Previous negative response to ketamine

You should and will always undergo ketamine therapy under direct medical supervision.

Ketamine Overdose and Abuse

Ketamine has been known to be used as a “club drug” used by teens and young adults at bars, nightclubs, concerts, and parties. The drug is a controlled substance, meaning that it is regulated and illegal to use recreationally. It can be found in both powder or liquid forms, to be injected, mixed with beverages, or added to smokable materials. 

Abusing or using ketamine in an uncontrolled way holds many risks. Ketamine can distort your perception and cause you to feel disconnected and out of control. A ketamine overdose can cause unconsciousness and potentially fatal respiratory problems.

Ketamine Therapy for Depression Frequently Asked Questions (FAQs)

Below we provide additional information if you are considering ketamine therapy for depression.

Does insurance cover ketamine therapy?

You will find that the majority of insurance companies do not cover the administration of ketamine infusion (IV) treatment as it is an off-label use. Many insurance companies do however cover Esketamine nasal spray because it has been FDA-approved as a treatment for depression. It is recommended to speak with your insurance agent and/or health care professional to better understand which ketamine treatments are covered. 

Can I get addicted to Ketamine?

Ketamine can be abused and lead to “moderate or low physical dependence or high psychological dependence”. However, addiction is highly unlikely to develop when administered in a professionally monitored setting, which is the only option for ketamine therapy. Additionally, the small doses of ketamine given while undergoing ketamine therapy lessen the likelihood of addiction.

What are other options for depression treatment?

Other explored treatment options for depression include antidepressant medication and therapy. The most commonly prescribed medication for depression is SSRIs, but there are other options including Tricyclic Antidepressants, and Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs). Finding the right medication is an individualized process, one medication might work well for you, but not at all for another. For this reason, there is no “right” antidepressant to take, and you should work with your doctor to find what works best for you.

Another way to combat depression is through therapy. There are numerous types of therapies used for treating depression, one of the most common being Cognitive Behavioral Therapy (CBT). Therapy is again, an individualized process, where one type of therapy may work for one but not the other. Therapy can range in price, but there are many affordable therapy options to explore.

How will I know which depression medication is right for me?

This comes down to trial and error. In addition to hearing your medical history, needs, goals, and treatment response, your provider will determine the best treatment plan for you. Your doctor will initially recommend a treatment for you and monitor your response. Based on this, you will either receive a new recommendation or continue with your current treatment to help improve your symptoms.

Bottom Line

Ketamine therapy is a potential treatment option if the usual treatments for depression do not work for you. Ketamine and esketamine treatments are fast-acting and usually work well for people with treatment-resistant depression. Ketamine has the potential to treat depression and improve many people’s well-being. However, it is important to remember that Ketamine is not the sole answer, but rather a small piece of a larger treatment plan. 

If you need help finding a mental health provider, our team at Mira can help you find one close to you. For $45 per month, Mira provides access to discounted prescriptions, low-cost lab testing, and affordable urgent care visits for all of your health needs. Sign up today!