Can Ketamine Be Used For Treatment Resistant Depression?

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By: Raul J. Rodriguez MD, DABPN, DABAM, MRO Special to the Boca and Delray newspapers
Treatment resistant depression is one of the most difficult conditions to treat in all of psychiatry. Characterized by an often-disabling degree of depression that responds poorly to multiple different medication regimens, treatment resistant depression can destroy quality of life and diminish functional capacity for decades at a time in afflicted individuals. Some people just give up and resign themselves to a life of misery. Others keep struggling to get better but do not know what to do. Options can run thin after 1 or 2 bad years of repeated failed treatments. Regardless of what someone may have been through, there are likely still a few potentially effective options that have not yet been tried.
Many different treatments have been developed over the years in an attempt to treat this severe grade of depression. There are many medications and medication combinations that could be tried, but limited effectiveness may be experienced with treatment resistant depression. Electro Convulsive Therapy (ECT) is often very effective yet frequently has severe side effects such as loss of memory. Transcranial Magnetic Stimulation (TMS) can also be effective in many cases but can be cost-prohibitive for some patients. Effective options that are both tolerable and affordable have been limited until recent medical developments have offered new hope.
Recent clinical trials have demonstrated very encouraging results for the use of Ketamine in treatment resistant depression. Ketamine, which has been used for many years as a form of anesthesia, has been shown to yield robust and rapid responses for depression when given in lower doses. Protocols have been developed where a specifically calculated amount of ketamine, based on the patient’s body weight, is administered intravenously over a specified period of time to yield an effect. The desired effect is a notable mood lift while still fully awake and alert. The dosing is managed so as to avoid putting the patient to sleep. The mood elevation is notable and may last up to several weeks after even just one administration. Many cases will require subsequent ketamine infusions with some regularity that may be weekly or monthly. Most cases maintain a very strong clinical response over time.
The notably high effectiveness in treating some of the most treatment resistant depression cases has given Ketamine a certain distinction in Psychiatry. Some cases that had long been written off as hopeless were turned around within the first 30 minutes of a Ketamine infusion. People who previously could not function have had their lives restored after a series of successful Ketamine treatments. Aside from being highly and rapidly effective, Ketamine is well tolerated with minimal to no side effects. Ketamine infusions for depression are generally affordable and can be far more cost-effective than other treatments such as Transcranial Magnetic Stimulation (TMS).
A therapeutic Ketamine infusion can be an exceptionally effective option for treatment resistant depression in clinically appropriate cases. Response rates are typically high and can be achieved quickly. Many of the few patients who did not respond initially to standard protocol dosing can still achieve a response if the dose of Ketamine is adjusted. Some patients experience a response lasting over 6 weeks after a single infusion. Many patients receive monthly to weekly infusions to maintain a strong response. In most cases the response has been strong enough to achieve actual full remission of depressive symptoms.
Full remission of depressive symptoms is the ultimate goal of any antidepressant treatment regimen. The Ketamine infusion is a powerful tool available to achieve this goal. All patients must first undergo a Psychiatric evaluation, after which all of the different treatment recommendations are discussed. Ketamine infusions may be an appropriate option in treatment resistant cases, with the best results coming as part of a comprehensive approach that includes individual and group psychotherapy, optimized nutrition, and exercise.
Dr. Rodriguez is the founder, CEO and Medical Director of the Delray Center For Healing, which offers a comprehensive depression treatment program that consists of advanced medical treatment such as therapeutic Ketamine infusions, DBT therapy and skills training, and integrative treatments.