The Benefits of Ketamine Therapy for Depression

Used for decades as a surgical anesthesia, ketamine has been making waves recently for the treatment of depression. But with increasing availability, experts advise that although the promising mental health therapy can be life-changing for some, it isn’t for everyone.

How Ketamine “Reshapes” the Brain

Scientists believe that depression may be due to a connection problem between nerve cells in areas of the brain that regulate mood. Research suggests that people with long-term depression may have fewer of the synapses that allow these nerve cells to communicate.

Medically supervised ketamine infusion therapy has been found to reactivate existing connections and to grow new ones, helping the brain to “shake loose” negative thoughts and shift out of depression. Because the brain has actually been “reshaped,” it may explain why antidepressant medications that didn’t work in the past, may help after ketamine therapy.

A 2000 study conducted at Yale University School of Medicine showed that ketamine therapy significantly reduced depression symptoms within four hours, with effects lasting up to three days or more. “Additional, more recent studies have shown that when medically supervised, ketamine can be highly effective in treating depression when other therapies have been ineffective,” says Keming Gao, MD, PhD, Director of the Ketamine Infusion for Depression Clinic at University Hospitals.

Although ketamine can be administered in many ways (oral, nasal spray and injection), intravenous (IV) infusion is the most extensively studied method to date. “Most patients will require multiple infusion sessions to experience symptom relief, which may vary from less than one week to 7-8 weeks or longer,” says Dr. Gao.

Ketamine treatment can be temporary or lifelong depending on a person’s treatment history and an evaluation of the risks and benefits. Because ketamine therapy isn’t typically covered by insurance, cost can be an issue as well.

What Are the Side Effects of Ketamine Therapy?

Ketamine works by blocking certain receptors in the brain, which can cause a dissociative experience or what may be described as a “trip.” Sensations may include feelings of elation or euphoria and distorted feelings about one’s body, such as the feeling that you are floating.

In addition to these effects, some people may experience nausea, dizziness, headache, pronounced drowsiness, blurry vision, mood changes, sensitivity to light and sound and temporary elevation of heart rate and blood pressure. Most side effects are fully resolved 30 minutes after the infusion therapy is stopped but some people may experience them for an hour or more.

Long-term ketamine use may also lead to bladder damage, urinary problems and liver-toxicity in some patients. Ongoing, in-person monitoring by a medical professional is essential to mitigate these potentially serious side effects. Although some telehealth providers will prescribe ketamine nasal spray without an office visit, this is not recommended for patient safety reasons.

“There is also the risk of addiction,” says Dr. Gao. “Ketamine is a controlled substance and people can develop a tolerance for it. Over time, they may come to require higher doses to achieve the ‘ideal’ effect – in other words, they become addicted to and dependent on the medication. Prescribers must be aware of this risk and should not prescribe ketamine for unsupervised use at home.”

Who Is Eligible for Ketamine Therapy?

Ketamine infusion therapy may be an option for patients with treatment-resistant depression that has not responded to traditional therapies, including medications and psychotherapy. Perhaps the more important question is, who is not eligible for this kind of treatment? The risks of ketamine therapy may outweigh the benefits in patients with certain risk factors or health conditions, including:

• Cardiovascular disease (hypertension, angina, heart rhythm disorders, history of heart attack or stroke)
• Hyperthyroidism
• Severe liver disease
• Psychiatric disorders (delirium, acute psychosis, schizophrenia)
• Alcohol or drug abuse
• Pregnancy
• Mobility restrictions

Patients should discuss their unique risk factors and the potential benefits with their doctor before starting ketamine therapy.

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Patients with depressive symptoms that have not responded to traditional therapies should talk to their psychiatrist about ketamine infusion therapy as a potential treatment. For some people, this relatively new and innovative approach can offer significant, even life-saving benefits.