Ketamine’s emerging potential for treatment-resistant depression

Ketamine’s emerging potential for treatment-resistant depression

The anesthetic medication ketamine has a history of being abused for it’s mind and mood-altering effects, but recently has been studied as a possible medication for treatment-resistant depression and other severe mental health conditions.  The research is the early stages, but the results are intriguing.

Medscape Psychiatry posted “Ketamine for Treatment-Resistant Depression: Recent Developments and Clinical Applications” on June 21, 2016. This is a long article which provides detailed information about recent research and thinking about the treatment of severe, particularly treatment-resistant, depression with ketamine. The article notes that about one third of patients with MDD do not respond to traditional treatment. The article reviews the current thinking about how ketamine affects the neurotransmitter system in patients with treatment-resistant depression, and pulmonary, but remarkable, research outcomes which find that a very high percentage, often 75 to 80%, the patients who have not responded to previous treatment obtain benefit from brief treatment with ketamine. The research also finds that these results occur quickly, within days, or even hours, and persist for significant measurement periods, assessment so far occurring several weeks or even several months after the treatment.

The article also references preliminary, but intriguing, research about the benefits of ketamine treatment for people suffering from bipolar depression, PTSD, and acute suicidal risk.

Of course, these studies are preliminary, so far have had culturally small number of participants, and also have not yet had time to assess the durability of the results over a period of years. As they say, “more research is needed.” The pulmonary findings are, however, very intriguing.

The authors conclude:

In conclusion, a critical number of studies support the efficacy of ketamine as a rapidly acting treatment for patients with TRD, while some studies also suggest efficacy in bipolar depression, PTSD and in those with acute SI. At this point, clinicians and patients should be aware of the limited information available regarding optimal dosing and long-term effects of ketamine treatment. We remain, however, cautiously optimistic and believe that ketamine has the potential to become a very important tool in the clinical treatment of severe mood and anxiety disorders.

Medscape Psychiatry also followed up with “Ketamine’s Antidepressant Effects: New Insight” on 9-27-16. This article reports on recent research that has teased out more specific understanding of how ketamine affects the human brain, and which may enable researchers to isolate the metabolites of ketamine that are therapeutically effective from the metabolites that cause mood-altering brain changes that can be abused by recreational thrill seekers.

Finally, here is an interesting study that did not find significant benefit for ketamine treatment. From Clinical Psychiatry News, “Ketamine augmentation doesn’t boost ECT outcomes” reports on a study that added a low dose ketamine to the anesthetic routinely used for ECT. The thinking was that, based on the emerging evidence of benefits of ketamine for people with severe depression, adding the drug to the ECT anesthetic would improve the benefits of ECT treatment. The ECT treatment group was found to have only a slight, not statistically significant, increase in treatment response in comparison to the control group.

Locally, there is a psychiatrist who provides a ketamine clinic. Brian Johns, MD, MFA participated in ketamine research at the Minnesota VA, in affiliation with the University of Minnesota, and also completed advanced training in integrative medicine at the Center for Mind-Body Medicine in Washington DC. Is now on staff at North Memorial Medical Center and provides services for the NMMC Partial Hospitalization Program.

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