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August 10, 2022

How safe is Ketamine for treatment-resistant depression?

How safe are outpatient ketamine clinics? Ketamine is approved for the treatment of difficult-to-treat depression.

How safe is Ketamine for treatment-resistant depression?

An uncommon class of psychedelic drug known as a dissociative, ketamine, is experiencing a resurgence in use. Ketamine, sometimes known as "special K," is a common anaesthetic used in hospitals and veterinary clinics that was originally developed from PCP, also known as "angel dust."

Both ketamine's medical and recreational uses are supported by its effects, which include pain control, amnesia, intoxication, dissociation, and euphoria. Due to its clearance for treating treatment-resistant depression (TRD), which is severe depression that has not improved with other therapy and includes people who are experiencing suicidal thoughts, it has recently become more extensively used.

Evidence of ketamine's benefits


Esketamine (Spravato), a prescription form of ketamine that is administered through a nasal spray, was approved by the FDA in 2019 for TRD. However, the rules state that it can only be used "under the supervision of a health care professional in a qualified doctor's office or clinic." Therefore, medical personnel must watch you using it and then follow you after you've taken your dose to monitor your vital signs and your overall clinical progress.

In research when ketamine was compared to a placebo, depression scores decreased subjectively and statistically significantly, and the efficacy of ketamine for TRD was first shown for short-term treatment. (In both trial groups, patients continued taking their normal antidepressants out of anxiety that TRD wouldn't be treated in the placebo arm.) In a study where ketamine (together with the standard antidepressant) helped patients stay in stable remission 16 weeks into treatment, it was discovered that nasal ketamine has longer-term efficacy.
 
With ketamine, TRD relief happens quickly. People who are struggling with the crushing weight of depression can start to feel the effects of ketamine in about 40 minutes, whereas they may have to wait weeks for an SSRI to help.
 
Is ketamine the best course of treatment for you? 
Your primary care physician, your mental health professional, and any other healthcare providers who are involved in your treatment should be involved in this conversation. Keep in mind that ketamine is not a first-line treatment for depression and is typically only used when other, more established treatments have failed. It is not regarded as curative; rather, it is thought to alleviate symptoms for a limited time. By looking at the bad effects, it is easier to figure out who shouldn't get ketamine treatment.
 
Should you seek therapy at a ketamine clinic? 
Ketamine outpatient clinics run independently are springing up everywhere. These clinics are thought to number in the hundreds to thousands at present, practically all of which were started when ketamine was authorised for TRD in 2019. These clinics are typically for-profit businesses with a staff that includes a nurse, a social worker, a psychiatrist or anesthesiologist (who can administer the infusion), and (of course) the entrepreneurs who make it all run.
 
How safe are ketamine clinics? 
These ketamine clinics present a number of concerns, such as what to look for in a reliable ketamine facility. We don't currently have any conclusive responses to that query. One wonders whether ketamine infusions, which can result in a deep dissociation from reality, would be better managed in a hospital setting where there are guidelines for safety in case something goes wrong. The level of communication, if any, between the ketamine clinic staff and your healthcare providers was unclear (in part because I didn't actually follow through with the therapy), and normally the treatments you receive wouldn't be recorded in your primary electronic medical record.

 
What are the side effects? Ketamine is generally regarded as safe, even for people who have suicidal thoughts (thoughts or plans for suicide). Dissociation, drunkenness, sedation, elevated blood pressure, headaches, impaired vision, anxiety, nausea, and vomiting are the prominent adverse effects. In the following groups, ketamine usage is either avoided or approached with great caution:
 
People with a history of substance use disorders should avoid ketamine because it can cause euphoria (likely by activating the opioid receptors) and some people can become addicted to it. people with a history of psychosis or schizophrenia because there is concern that the dissociation ketamine produces can exacerbate psychotic disorders (which is called ketamine use disorder). teenagers, as there are some worries about ketamine's long-term effects on the still-developing adolescent brain; women who are pregnant or nursing; elderly people who have dementia symptoms.

The long-term benefits and risks of ketamine therapy, as well as its safety and effectiveness for teenagers and older people, as well as its newly emerging uses for PTSD, OCD, alcohol use disorder, and other mental health problems, all need more research.
 
Finally, there is some worry that ketamine may start to lose its potency with repeated doses and require higher doses to have the same effect, which is unsustainable.
 
Ketamine may offer hope to those suffering from severe depression. People with severe, treatment-resistant depression may lose hope in their future and in their ability to ever feel better. Patients who have not had relief from prior treatments may find relief and hope with ketamine. It is possible that ketamine could save lives, given its effectiveness in preventing suicidal thoughts in people.
 
We'll be better prepared to respond to inquiries about ketamine's long-term effectiveness and what protections are required for therapy as we learn more from ketamine research and from people's experiences in more recent clinics. Additionally, we might find out which patients are most likely to benefit from ketamine treatments and which delivery method—an intravenous infusion, a nasal spray, or a pill—is the most effective.
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