Ketamine Therapy Offers Hope for Treatment-Resistant Depression

The search for relief from depression symptoms generally follows a well-trodden path of psychotherapy and medication. Unfortunately, while various combinations of therapy and first-line antidepressants do prove successful for many patients, this standard approach does not work for every patient. It can take months of trial and error to fine-tune dosages of medication, and not every patient responds well. Similarly, psychotherapy is a staple of any good treatment plan, but therapy can also fall short when relied upon as the sole treatment method.

Fortunately, when psychotherapy and psychotropic medication fail to alleviate symptoms, there are other therapeutic options available to treat depression. Current research has isolated an area of the prefrontal cortex (the dorsolateral prefrontal cortex or dlPFC) for targeted depression treatment The dlPFC is an attractive target because it is involved in both emotion regulation as well as executive functions that are affected in many people with depression.

In March of 2019, the FDA approved a derivative of the anesthetic ketamine for use in treating the symptoms of depression. Esketamine, delivered via nasal spray, has been demonstrated to encourage neuronal growth in the anterior cingulate cortex. Unlike traditional psychotropics, which can take weeks to take effect, ketamine depression treatments act much faster. In laboratory trials, new neuron growth was detected just one day after treatment was administered. Researchers tout ketamine’s ability to promote cellular development as a result superior to those of the SSRIs commonly used to treat depression, in that the effects of ketamine remain even when the drug is not actively present in the body. While the esketamine nasal spray is a relatively new option, ketamine depression treatment has been administered to upwards of 15,000 people through IV infusions.

So what is ketamine treatment for depression like? Generally, your physician will begin treatment with a few infusions per week, and then gradually taper off the dosage week by week. Each infusion takes around 90 minutes. Effects of the infusion typically last for a few days or weeks, so regular infusions are necessary at first.

Are there side effects? There have been a few. Many are the kind of thing you’d find on the warning labels of any medication. Nausea during the first infusion is possible, as is elevated blood pressure. Some patients have reported a ‘floaty’ feeling while taking an infusion. Others have described it as a ‘twilight’ sensation that subsides as the infusion ends.

Ketamine does have a reputation as a party drug that can be abused, which leads some patients to worry about possible addiction. However, because the ketamine is administered in controlled, low doses, the potential for addiction as a result of treatment is very low.

Ketamine treatment for depression is a viable secondary option to look at when deciding on a course of action after psychotherapy and medication have failed to deliver satisfactory results. While other secondary treatment options like electroconvulsive therapy (ECT) have a good track record of treating depression, the side effects and use of general anesthesia make it a daunting prospect for many. Ketamine treatment for depression isn’t the only low impact option available for treatment-resistant depression, however. Transcranial magnetic stimulation (TMS) is a drug-free, anesthesia-free outpatient therapy in which the dorsolateral prefrontal cortex is stimulated by a magnetic field in order to promote neuronal activity in the portion of the brain that has been pinpointed as a key area for emotional regulation and executive function. Like ketamine treatment for depression, TMS takes place over several treatments. Unlike ketamine, there are no physiological side effects and no danger of addiction. Both treatments offer modern, effective approaches to managing treatment-resistant depression.

Meet Jonathan Horey, MD

Dr. Jonathan Horey became familiar with TMS while training and working at Columbia University in New York City where many of the early and important studies on TMS were conducted. Dr. Horey has since completed more extensive training in TMS and keeps himself up-to-date with the latest research on brain stimulation techniques, including TMS.