Ketamine Injections for Treatment Resistant Depression
Depression continues to be a disease that is not completely understood. Modern neuroscience has come up with logical and cohesive models, which describe depression as the deficiency or reduced activity of the neurotransmitters Serotonin, Norepinephrine and Dopamine in the brain. All FDA-approved medications affect one of or more of the above neurotransmitters.
The art of psychopharmacology is to find the right combination of medications that will optimize the activity of the three aforementioned neurotransmitters for a given patient. However, current models of depression do not explain why antidepressants do not work instantly or why antidepressants do not work for all depressed patients. To complicate matters further, current research shows that Ketamine, an old anesthetic, works very quickly in relieving the symptoms of severe depression in patients who had no response to medications and/or ECT.
How does Ketamine work?
The exact mechanism of how Ketamine works for treating depression is not fully known. Ketamine works on a neurotransmitter system called Glutamate (NMDA receptors), which is the most widespread neurotransmitter in the brain. Many major research institutions are conducting trials and studies on this subject. The public clinical results are excellent, but the mechanism of action still remains a mystery.
Is Ketamine safe?
Ketamine has been widely used as an anesthetic for minor procedures since the 1960s. In many countries, it is used by first aid response workers when dealing with minor trauma. The safety of Ketamine is such that it is used as outpatient anesthetic by non-physicians. The dose used to treat depression is about one quarter (1/4) of anesthetic dose. At Trifecta, we administer a trial injection, followed in 15 minutes by regular injection. This is to minimize the chance of any negative reaction and to reassure the patient. Ketamine is very short-acting. The mind-altering effect is frequently compared to a mild alcohol intoxication and lasts less than two hours.
Most of the negative effects of Ketamine use are associated with medical errors or high chronic doses of Veterinary grade by recreational drug users (Special K). Ketamine is an FDA approved substance, but does not carry an indication for depression treatment.
How does Trifecta use Ketamine for Treatment Resistant Depression?
Appropriate patients are selected by the medical team. EKG, vital signs and oxygen saturation are monitored. During a treatment session, the patient is given two injections, 10 minutes apart. The patient is awake and aware of his or her surroundings, but feels mildly intoxicated.
Usually, patients report the subjective experience of the Ketamine-induced state as pleasant. They are expected to stay at Trifecta Health Medical Center for a period of two hours during the procedure. Following the ketamine treatment, the patient is discharged fully awake, oriented and sober.
Trifecta treatment philosophy
We create a unique treatment plan for each individual patient. Lamictal treatment is frequently used as an adjunctive treatment, to both improve the efficacy and reduce potential side effects of ketamine. We charge for each session separately, since it is impossible to predict how many treatments would be necessary. At Trifecta, we strive to make the patient a full partner in the treatment process.
What to expect from Ketamine Injection treatment for Treatment Resistant Depression?
Expect a very pleasant experience. It is reasonable to expect improvement within 24 hours of the treatment. Normally, treatments occur twice a week for two weeks and continue weekly after that, for a total of 12 to 16 treatments. The goals of Ketamine treatment for depression are rapid recovery, stabilization, maintenance of effect and, if possible, transfer to more traditional oral medications. Ketamine maintenance is possible, if absolutely necessary.