Bruce Alan Kehr, M.D. is the Founder and President of Potomac Psychiatry, ranked “Best Psychiatry Care Provider in Maryland” in 2020 by Global Health & Pharma. He has been named a Washingtonian Magazine “Top Doctor” for each of the past eight years. Dr. Kehr is a best-selling author whose works have been read by over 800,000 people in 206 countries. In 2020, Dr. Bruce Kehr’s blog was ranked #2 in the nation among mental health-related blogs. Dr. Kehr’s book, Becoming Whole: A Healing Companion to Ease Emotional Pain and Find Self-Love, is an Amazon Best Seller in the self-help categories: Happiness, Counseling, Healing, and Self-Esteem.
An estimated 16.1 million adults in the United States have suffered from severe depression in the past year. This number represented 6.7% of all U.S. adults.[i] Sadly, a third of those who seek treatment find existing antidepressants ineffective.[ii] This means that millions suffer through their emotional pain without much hope or viable options. Some doctors and patients, however, are pinning their hopes on a new use for an old drug to treat severe and “treatment-resistant” depression – ketamine.
Ketamine is a drug that has long been used as an anesthetic. Administered to patients with acute pain ̶ such as for surgery ̶ and to severe burn victims. Ketamine is also known as the street drug Special K which, in large doses, can cause hallucinations and out-of-body experiences. However, recent research shows promise for the use of low-dose infusions of ketamine to rapidly reduce and even eliminate symptoms of depression, including suicidal thinking. Additionally, data exists demonstrating the benefits of ketamine in post-traumatic stress disorder (PTSD) as well as obsessive compulsive disorder (OCD). However, improvements in these conditions tend to be short-lived with single infusions.[iii] The long-term effects of its use, however, are not well known. If you or someone close to you is suffering from severe treatment-resistant depression or OCD, please continue reading to learn more about ketamine as a potential option.
How is Ketamine Different?
Ketamine is fast acting. Patients who have taken the drug after a long trial with standard antidepressants have experienced relief within a few to 24 hours. One of the primary concerns with conventional medications to treat depression is that they can take several weeks or more to deliver relief. Patients may end up spending years working with their doctors to identify a medication that works for them ̶ an incredibly frustrating experience for both patients and clinicians.
Another key differentiator is that ketamine works on a different neurotransmitter system in the brain. Many of you have heard of serotonin, norepinephrine, and dopamine regulation with medications such as Prozac® and Effexor®; ketamine is different because it works on the neurotransmitter glutamate. Ketamine inhibits NMDA receptors that regulate glutamate.[iv] Scientists know that normal functioning of the glutamate system plays a vital role in learning, memory and brain development; and that excessive amounts of glutamate are “toxic” to brain cells and the synapses that connect them, resulting in symptoms of severe depression.[v]
Further Research is Needed
Ketamine has not been studied in long-term trials for safety and effectiveness, and is not approved by the Food and Drug Administration (FDA) for the treatment of depression, PTSD or OCD. When doctors prescribe ketamine it is “off label” and usually after exhausting all other options. Yet, just last month, the American Psychiatric Association released a consensus statement acknowledging that the drug could be considered a breakthrough treatment for severe depression. The statement authors write that current research establishes that ketamine therapy is a “rapid and robust, albeit transient” response for severe clinical depression.[vi] By transient they mean that the effects are short-lived, requiring multiple continuing infusions over time, perhaps indefinitely.
With regard to side effects, these have not been studied over the long-term either. Clinicians have found that bladder problems and cognitive deficits have been reported among long-term ketamine abusers ̶ yet, none of these effects have been observed in low-dose clinical trials.[vii] In addition to depression, the drug is being studied for its effectiveness in treating OCD and PTSD as mentioned earlier, but also extreme anxiety and Rett syndrome (a rare developmental disorder on the autism spectrum).
A Future For Ketamine in Psychiatric Medicine
A growing number of psychiatrists as well as the general public are becoming aware of the novel benefits of ketamine. Some experts are calling ketamine “the most significant advance in mental health in more than half a century.”[viii] Ketamine clinics are popping up in small numbers nationwide. Advocates explain that when nothing in your medical bag works, then it’s almost unethical not to try ketamine. A more balanced view is presented in the article, “Ketamine for depression: evidence, challenges and promise” published by the World Psychiatric Society.[ix] The drug offers hope for the most severe and complicated mood disorders that baffle psychiatrists today. A deeper look into the research and discussions with your psychiatrist may be warranted if you want to consider the risks and benefits of ketamine for persistent and severe depression, OCD and PTSD.
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