Author: Charles Frank

Who Is Eligible for Ketamine Therapy?: Allied Psychiatry & Mental Health: Psychiatrists

But research shows that within 24 hours of the first dose of medically supervised ketamine, those lost connections start to regrow. The more synapses the patients grow, the better the antidepressant effects of ketamine are for them. Injection ketamine hydrochloride was available in vials of 5 ml each. A volume of 1 ml contained I.P equivalent to 50 mg and benzethonium chloride USP 0.01% w/v. Providers have been using ketamine to treat patients with a wide variety of psychiatric conditions. At Columbia University Irving Medical Center, doctors work with patients to individualize their clinical approach.

1. Ketamine therapy is thought to have rapid-acting antidepressant effects, with many patients reporting improvements in their symptoms within hours to days after treatment.
2. It’s important to remember that ketamine isn’t a first-option treatment for depression, and it is generally used only when other, more longstanding treatments haven’t been effective.
3. Other methods include a nasal spray or a series of injections, depending on the patient, the therapist, and the treatment setting.
4. There is no standard recommendation for when or if people need a booster.

The use of ketamine as an antidepressant has mainly been studied for the treatment of treatment-resistant depression(TRD). This is in sharp contrast with currently-approved treatment options, whose delayed onset poses an increased risk for suicidality in patients. However, this potency cannot currently be generalised for non-depressed patients experiencing suicidal ideation. Ketamine therapy is a treatment approach that uses low doses of ketamine, a dissociative anesthetic medication, to manage various mental health conditions, such as treatment-resistant depression, anxiety disorders, and post-traumatic stress disorder (PTSD).

Like the drug itself, Stewart got his start in combat medicine during the Vietnam War. Usually ketamine treatment includes one or a few in-clinic ketamine dosing sessions under clinician supervision integrated with preparatory and integration counseling. 2-chlorobenzonitrile is reacted with the Grignard reagent cyclopentylmagnesium bromide to give (2-chlorophenyl)(cyclopentyl)methanone.

What is Ketamine Therapy?

This is then brominated using bromine to form the corresponding bromoketone, which is then reacted with methylamine in an aqueous solution to form the methylimino derivative, 1-(2-Chloro-N-methylbenzimidoyl)cyclopentanol, with hydrolysis of the tertiary bromine atom. This final intermediate is then heated in decalin or another suitable high-boiling solvent, upon which an Alpha-ketol rearrangement occurs resulting in a ring-expansion, and the formation of racemic ketamine. Research is, of course, still ongoing for KAP and other psychedelic psychotherapies. While this doesn’t mean KAP will be a guaranteed fix, it opens a much-needed door for people struggling to progress with more traditional forms of therapy. Many have found that the experience of KAP led to therapeutic breakthroughs at an exponentially faster rate than traditional talk therapy. They’ve uncovered repressed memories, faced previously unbearable emotions, and even found the purpose they have been searching for.

As with any practice that involves bringing up painful feelings and experiences, things can feel a lot worse before they start to feel better. Anyone looking into KAP should keep this in mind and discuss a potential plan with their therapist if necessary. During a typical KAP session—prefaced by thorough evaluation and discussions with the provider—a patient will usually lie down in a quiet room and take the prescribed dose of ketamine. Providers might put on soft music or have patients wear an eye mask to keep the environment as relaxed as possible. In 2019, ketamine became the first psychedelic drug to be approved by the FDA for use in treatment-resistant depression.

Receiving Ketamine

Independent, outpatient ketamine clinics are popping up all over the place. It is estimated that there are currently hundreds to thousands of these clinics — almost all of which were established in 2019 when ketamine was approved for TRD. Typically, these clinics are for-profit enterprises that are staffed by some combination of either a psychiatrist or an anesthesiologist (who can administer the infusion), a nurse, a social worker, and (of course) the businesspeople who make it all work. Ketamine is an unusual type of psychedelic drug — called a dissociative — that is undergoing a resurgence in popularity.

Unpleasant thoughts, painful memories, stubborn beliefs about ourselves and the world? These are not always easy things to sit with, let alone long enough to deal with. Table 1 shows that the majority of the patients were Hindu (90%), with secondary education (75%).

Assessments were made at baseline and injection ketamine hydrochloride was given at a subanesthetic dose of 0.5 mg/kg intravenous bolus after preparation. The FDA has warned that ketamine and compounded ketamine products aren’t approved to treat any psychiatric disorder. In 2019, the FDA approved a nasal spray called esketamine (Spravato) that’s derived from ketamine for treatment-resistant depression, but only in certain people who also take oral antidepressants and only under strict controls in certified health care settings. It may be an option for people who either haven’t been helped by antidepressant pills or who have major depressive disorder and are suicidal. They continue to take their antidepressant pill and receive esketamine at a certified doctor’s office or in a clinic, where a health care provider watches over them for at least 2 hours after the dose.

Subtle Signs of Depression in Young Adults

It may be too soon to tell whether the risk of addiction or tolerance outweighs the possible benefits. It’s important to note, though, that some recommendations suggest it may not be safe for people who have a history of substance abuse. “I think it’s probably less addictive than opioids, but it’s not without its risks,” says Shatzberg, who is the director of Stanford University’s Mood Disorders Center. Indeed, case studies have described people who showed signs of addiction or abused the drug.

“We specialize in treatment-resistant depression, which is depression that hasn’t responded to traditional forms of medication or psychotherapy,” says Jacques Ambrose, MD, MPH, senior medical director at ColumbiaDoctors Psychiatry. Instead of waiting for an SSRI to hopefully provide some relief over the course of weeks, people who are suffering under the crushing weight of depression can start to feel the benefits of ketamine within about 40 minutes. Table 2 shows that the mean age of the sample population was 33.55 ± 8.80 years.

Evidence of the benefit of ketamine

As director of the Treatment & Research In Psychedelics (TRIP) program, he is involved in the development of psychedelic-assisted therapies for those suffering with addiction, depression, anxiety, and PTSD. Dr. Heinzerling is a trained psychedelic guide and holds a Certificate in Psychedelic-Assisted Therapies and Research (CPTR) from the California Institute of Integral Studies (CIIS). Patients with depression, anxiety, PTSD, end-of-life distress, chronic pain, drug/alcohol problems, and other conditions may be eligible for psychedelic-assisted therapy with ketamine. Notably, patients tend to report few side effects from KAP, aside from those typically expected from psychedelic substances—dizziness, nausea, vomiting, and increased heart rate being the most common. Treating mental illness is not often as simple as weekly talk therapy or daily medication.

Ketamine offers an alternative

Selective serotonin reuptake inhibitors (SSRIs) are a first-line antidepressant drug. They increase serotonin levels by stopping neurons from reabsorbing serotonin. Unfortunately, not everyone responds the same to medications and can experience side effects. In writing this piece, I called several ketamine clinics, posing as a patient, to investigate what would be involved in receiving ketamine therapy.

Since then, research and personal anecdotes have painted a successful picture of ketamine in treating anything from depression to addiction to post-traumatic stress disorder (PTSD). Sociodemographic and clinical data sheet for recording relevant data, Hamilton Depression Rating Scale (HDRS) for assessing the severity of depression,[12] Hamilton Anxiety Rating Scale (HAM-A) for anxiety,[13] and clinical global impression (CGI) scale for the severity of illness[14] were used. Ketamine has a robust and rapid effect on depression, which was seen immediately after the administration of ketamine and sustained at the end of 1 month. IV ketamine therapy isn’t used as a first-line defense against depression, but for those who try it, it may bring you the relief you deserve. Columbia also serves as one of the major academic medical institutions that studies treatment-resistant depression and has one of the longest histories of clinical care for treatment-resistant depression. Because the FDA has not approved IV ketamine for depression, most insurance doesn’t cover it.

It’s as if the glutamate receptors – the catcher’s mitts – are deactivated or weakened. Weeks, months, or years after their first series of six to eight doses, patients may return for a booster. There is no standard recommendation for when or if people need a booster. They discuss it with their doctor if symptoms of depression start to reappear. Dr. Keith Heinzerling practices internal medicine and is an addiction medicine specialist at the Pacific Brain Health Center, Pacific Neuroscience Institute. His clinical and research focuses are on the treatment of alcohol, drug and substance use problems, with anti-addiction medications.

The brain can respond in a few ways, depending on the state it was in to begin with. For example, some people with long-term depression lose some important connections in their brains (called synapses) that let nerve cells communicate. Christa Coulter-Scott says ketamine treatment eased the depression she’s had for most of her life. There’s no research to suggest that more than 6 weeks in a row brings more benefits, though people do go back for boosters if symptoms return. According to both providers and patients, these trance-like states that ketamine can produce relax the walls that often come up when trying to address painful emotions. With these walls down, patients can access these things in a controlled environment without fighting against the mind’s natural defenses.