A Deeper Look Into Intravenous Ketamine Infusions For Treating Depression

As depression is on the rise, there is a race to discover an optimum treatment that is best suited for those affected. One such treatment that is yet to gain FDA approval for its use in treating depression is intravenous ketamine infusion.

Over the years, more and more people are turning to intravenous ketamine infusion due to its immediate relieving effects, but there has been much debate on whether this is an effective form of treatment.

Ketamine, an NMDA receptor antagonist, mainly functions as a general anesthetic. The NMDA or N-methyl-D-aspartate receptor is a glutamate receptor important in the function of memory as well as regulating synaptic plasticity. It plays a role in regulating the neurotransmission of glutamate in the brain. When this function is disrupted, depressive symptoms may arise. Ketamine blocks the NMDA receptor, which can help to counteract this disruption. This may produce some side effects in the form of vivid dreams and possibly a dissociative effect.

depression
Photo Credit: Nikko Macaspac

Until recently, Ketamine was most commonly known for being a street drug, particularly because of the hallucinatory effects it can create.

In 1970, the FDA had approved the use of ketamine as an anesthetic; however, the approval led to it being used as a psychedelic drug for its mood-altering effects. Individuals are known to abuse ketamine in four ways: sniffing, bombing, dabbing and injecting. Ketamine also has a reputation for being a date-rape drug. Ketamine increases heart rate and blood pressure, as well as a number of other side effects, but high doses can create an out of body experience, commonly referred to as the “K-Hole.” Punk rock band NOFX even dedicated an entire song to it.

To fall into a K-Hole means to be so extremely debilitated that one is unable to interact with others and the world around them. People have reported a lost sense of time, space, balance, and verbal skills. When individuals reflect on their past experiences, they tend to refer to it as one of the negative aspects of getting high on ketamine. Among those well versed in their chemicals, it’s a subject most people dread discussing.

The administration of intravenous ketamine, in a supervised medical setting, was primarily discovered in 2000 at Yale by Robert M. Berman and others, where they administered intravenous ketamine to seven patients and when compared to a saline placebo, they found that ketamine may play a role in reducing depressive symptoms. The National Institute of Mental Health also conducted a study in 2006 demonstrating that an intravenous dose of ketamine mimicked antidepressant effects.

Since insurance does not cover the use of ketamine to treat depression, patients have no other option but to pay out of pocket. Each treatment averages around $250. Vice conducted an interview with Brent Miles, 41, who received ketamine IV treatments from a clinic in North Scottsdale back in 2013. You can learn more about his experience here. When he first went to the clinic, he had to answer a series of 300 questions as a form of screening to ensure this treatment was appropriate for him and to weed out people who are just looking for a chemical experience. Since ketamine is not a one-size-fits-all drug, this thorough screening process is also very important in determining the dosage from patient to patient, which depends on factors such as weight and height. Furthermore, there was always a psychiatrist present to consult with Brent and the overall process took about two hours.

Currently, the FDA has not approved the use of ketamine for treating depression and it still has yet to be extensively researched for long-term effect and overall effectiveness. However, since this can take several years for it to be officially approved, many clinics offer intravenous ketamine treatment to those who desperately need it. Many doctors tend to go “off-label” meaning that they use drugs for a different purpose than the approved one and in the case of ketamine, many of these doctors conducted research showing the benefits it has for patients with depression.

As opposed to other antidepressants, Ketamine works immediately, often providing instant short-term relief.

However, an important point to address is that the treatment of depression should not rely on it or any other single form of treatment alone. All aspects of an individual have to be considered, from biological to psychological, as ketamine treatments are not intended to treat the core issue. An interesting effect of ketamine is that it can immediately reduce suicidal thoughts. When combined with other treatments such as medications, as well as psychotherapy, it can prove to be quite promising.

ketamine and depression
Photo Credit: Nicole Mason

In the Portland Ketamine Clinic, intravenous treatments are infused six times over a span of twelve days after the patient’s psychiatrist or primary care doctor has been consulted. Patients may experience some side effects such as confusion, hazy vision, and lucid daydreaming, but these last only briefly and are carefully monitored. Additionally, patients must have arranged for transport back home beforehand, as they are not allowed drive or operate heavy machinery for at least 24 hours after each treatment. As soon as the infusion has been complete, the side effects tend to subside. The beneficial effects tend to last anywhere from 3-5 weeks up to 12 weeks, depending on the patient.

Kyle A.B. Lapidus among others conducted a study that provided the first form of evidence for the use of intranasal ketamine, in the form of a nasal spray that produced rapid antidepressant effects in patients who have a form of depression that is treatment-resistant. They found this method to be quite effective and this may propose another approach in it’s use to treat depression. Consequently, future studies need to focus on how to prolong the soothing effect of ketamine and maintaining the benefits while minimizing its adverse effects.

Legally, “off-label” prescriptions are within the law, even though it’s not approved by the FDA, for its use in treating depression. A task force of the American Psychiatric Association released a statement regarding studies done on the effects of ketamine infusion, stating that there is compelling evidence that it produces rapid, robust, and transient antidepressant effects.

In U.S. and Canada, it has been reported that over 3,000 patients have been treated using this form of treatment.

However, there are several limitations to the treatment. For example, the antidepressant effects can fade quickly after administration of the ketamine dose, so this affects its viability as a long term treatment option. Additionally, other concerns regarding the research conducted on the treatment include, but are not limited to, the saline placebo not being an adequate point of comparison. It’s use as an anesthetic does not provide any evidence of whether continued use might lead to neurotoxicity.

Dr. Charles Nemeroff, who is the chair of psychiatry at University of Miami Miller School of Medicine and chair of the APA task force, brings up a good point about the uncertainty surrounding the use of ketamine to treat depression. Since it is a drug with a high potential for abuse, it is incredibly important to be fully aware of its effects otherwise substance abuse on top of depression may arise. Chronic use can lead to bladder inflammation and cognitive impairment.

There is still a long way to go before ketamine becomes approved and legalized for the treatment of depression. Similar to marijuana, there is a negative connotation associated with it, due to its prevalence as a street drug and hence, may be a reason why people avoid this treatment as an option to treat their depression. Thus, in the same way that marijuana has been facing hurdles in the name of nationwide legalization, legalization of ketamine will have to fight the same battles. For the time being, ketamine infusion treatments provide promising results in treating depression, due to its immediate effects and rapid reversal of suicidal thoughts, but it still needs to be thoroughly researched before we know whether or not intravenous ketamine treatments can be a long-term viable option.

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