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A Comprehensive Look at How Ketamine Treats Depression

A Comprehensive Look at How Ketamine Treats Depression
3 months ago · · 0 comments

 

Searching for Ketamine for Depression in Los Angeles? Do you believe you may be suffering from depression? If so, questions regarding receiving a diagnosis and treatments may also be on your mind. While the symptoms of depression aren’t always apparent, that doesn’t mean they aren’t real. Feelings of sadness and hopeless, as well as rage and obsessive-compulsiveness, could be part of the equation.

On the other hand, there could also be no feelings at all. If these challenges are making you feel stuck, take a hard look at any other feelings or behaviors that may be accompanying them. Once you determine their severity, consider speaking to a professional about your options for treating depression.

Treating Depression

According to the National Institute of Mental Health, approximately 17.3 Americans in America suffered in 2017 alone from at least one significant depressive episode. While many treatments are available for treating depression, two categories that are backed by solid research include psychosocial and somatic. Those falling under the psychosocial category are various forms of depression treatments, including cognitive-behavioral therapy (CBT), interpersonal psychotherapy (IPT), and other forms of psychotherapy. Treatments falling under the somatic category includes medications and antidepressants, transcranial magnetic stimulation (TMS), and electroconvulsive therapy (ECT).

There are many adverse side effects to the use of antidepressants and it isn’t uncommon for them to take weeks to start working. Berit Brogaard D.M.Sci., Ph.D. from Psychology Today writes, “Since our brain has plenty of active serotonin transporter molecules when we start taking antidepressants, it takes a while before the suppression of the genes that code for the transporter has an effect on serotonin in the brain.”

Harvard Medical Publishing reveals that, after taking an antidepressant, only one-third of individuals experiencing symptoms of major depression will achieve remission. However, the story doesn’t end there. The next course of treatment is to continue taking that medication in conjunction with another or to try another one. Once this change in therapy occurs, a study indicates that seven out of 10 individuals who suffer significant depression symptoms find a successful treatment, which leaves 3 out of 10 without the help that they need.

Receiving affordable and quality treatment for depression remains a challenge, as well. According to Mental Health America, there are more than 24 million Americans throughout the country with a mental illness who aren’t receiving treatment. These statistics further indicate the states with mental illness going untreated in adults range from Maine with 41.5% to Hawaii with 67.5%. These statistics highlight the need for consideration of accessible and useful treatment modalities to pharmacological, natural, or alternative treatments for depression.

Medication for Depression

It isn’t uncommon for professionals to turn to antidepressant medications for the treatment of depression. There are a variety of antidepressants available for treating these symptoms. These medications work to either reduce or take away depression symptoms.

How Does Your Physician Know Which to Choose?

Your symptoms are the best indicator regarding which antidepressant to choose. Your mental health professional will take a close look at the symptoms you’re experiencing, address any other medications you’re taking, consider the costs of the medicines, and look at the side effects that you may potentially encounter. If this is not your first time experiencing symptoms of depression, your physician may use a medication that you responded to well in the past. They may also ask you if your family has a history of depression, as well as any medications that they have responded to favorably.

A low dose of the antidepressant is typically where most patients start. If you don’t see results, your physician will gradually increase the dosage until the desired results are achieved. However, if side effects emerge, then you are limited as to how much, or even if, you can take that  particular drug.

How Long Are Patients on an Antidepressant?

When individuals receive a prescription for an antidepressant for the first time, physicians or mental health professionals typically prescribe antidepressants for six months to one year. That way, they’re confident the medication is effective and will prevent symptoms from recurring. Before the medication’s benefits can be experienced at their full-effect, they usually have to be taken regularly for at least two months. Your mental health professional will monitor you closely for effectiveness, as well as the development of potential side effects.

What are Common Types of Medications?

  • Atypical Antidepressants: trazodone, vilazodone (Viibryd®), and vortioxetine (Trintellix®).
  • Atypical Antipsychotics (Second-Generation Antipsychotics, or SGAs): aripiprazole (Abilify®), olanzapine (Zyprexa®), and quetiapine (Seroquel® and Seroquel XR®).
  • Newly-Approved Antidepressants: Selegiline (Emsam®).
  • Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs): bupropion (Wellbutrin®, Aplenzin®, Forfivo XL®) and Mirtazapine (Remeron®).
  • Monoamine Oxidase Inhibitors (MAOIs): isocarboxazid (Marplan®), phenelzine (Nardil®), and tranylcypromine (Parnate®).
  • Tricyclic Antidepressants (TCAs): amitriptyline, desipramine (Norpramin®), doxepin, imipramine (Tofranil®), and nortriptyline (Pamelor).

Treating Depression Naturally

Natural treatments for depression can include everything from changes in your sleep to altering your diet. Take, for example, a study that was published in the Molecular Psychiatry journal in 2018. Researchers in Australia, Britain, and Spain are linking unhealthy eating habits—specifically eating junk food—to a higher risk of the development of clinical depression. The research doesn’t have clear markers indicating that eating junk food is the specific cause of depression. However, it does show that those who are consuming foods that are heavily processed or contain high levels of fat at a higher risk.

Sleep also plays a significant role in an individual’s mental health. Katie Hurley, LCSW writes, “Sleep deprivation can have a profound effect on both the emotional and cognitive functioning of the brain. This results in bad moods, negative thinking, decreased empathy, and poor impulse control.” Many natural remedies are available to help with sleep issues which may, as a consequence, aid in treating associated depression.  

 Here are some examples:

  • No matter if it’s on the weekend or during a vacation, develop a sleep and wake schedule that you can stick to every day.
  • As soon as you feel tired, you must go to bed.
  • Don’t eat anything for at least two or three hours before retiring for the night.
  • Be sure you’re engaging in at least fifteen to thirty minutes of exercise daily.
  • Try reading in another room if you’re unable to achieve sleep after twenty minutes of trying to see if the change in setting makes you more sleepy.

Exercise is another natural way of treating depression. While the lack of exercise isn’t the cause of depression, getting more does help reduce its symptoms. According to a report published in the journal of JAMA Psychiatry, “Increasing evidence shows that physical activity is associated with reduced risk for depression, pointing to a potential modifiable target for prevention.”

The research further indicates that physical activity also leads to the reduction of inflammation. In doing so, individuals will see an improvement in their heart health, which both have links to symptoms of depression. The research study doesn’t have any clear explanation regarding how physical activity potential mitigates symptoms of depression. However, it does point out several possibilities.

Many are also turning to herbs and supplements as a way of treating depression symptoms naturally. Such herbs and supplements include examples like:

  • 5-HTP (5-hydroxytryptophan)
  • Chamomile
  • Ginseng
  • Lavender
  • Omega-3 fatty acids
  • Saffron
  • SAMe
  • St. John’s wort

Ketamine Treatment for Depression

Researchers are learning more about the use of ketamine as a very effective way to treat depression. When patients aren’t responding to antidepressants, natural remedies, or lifestyle changes alone, they want another option. That’s where ketamine has shown very promising results.

Those who are suffering from depression can now turn to the use of ketamine as a rapid-acting treatment. Use of other therapies, including natural and antidepressant treatments, can take weeks or months before patients can achieve results. Robert C. Meisner, MD, writes, “If a person responds to ketamine, it can rapidly reduce suicidality (life-threatening thoughts and acts) and relieve other serious symptoms of depression. Ketamine also can be effective for treating depression combined with anxiety.”

Dr. John Krystal began researching using ketamine as an antidepressant in the 1990s at the Yale School of Medicine with his colleagues Ronald Duman, Ph.D., and Dennis Charney, MD. Ultimately, studies from Yale indicated that ketamine triggers the production of glutamate. In doing so, the brain prompts the formation of new neural connections. Because the brain is now able to create new pathways,it is more adaptable, and so patients are more likely to develop positive behaviors and focus less on depressive thoughts. Professionals hadn’t seen these results previously with traditional medications..

During April of 2019, new research supported by the National Institutes of Health shows how ketamine can quickly reduce depression symptoms by altering brain circuits. Researchers from Stanford University in California, The University of Tokyo in Japan, and Weill Cornell Medicine in New York worked together to determine how ketamine battles depression in the brain using mice in their study.

The study’s conclusions show that, after three hours of treatment, ketamine infusions delivered marked behavioral improvements. The results also show that ketamine plays a significant role in maintaining remission.

“Ketamine is a potentially transformative treatment for depression, but one of the major challenges associated with this drug is sustaining recovery after the initial treatment,” points out Dr. Conor Liston, who is one of the researchers involved in the study. 

However, there is continuing research on improving outcomes for the treatment of depression through the use of ketamine. For example,  Carlos Zarate Jr., MD, chief of the Experimental Therapeutics and Pathophysiology Branch of the National Institute of Mental Health, indicates that your body breaks ketamine down into two dozen byproducts referred to as metabolites. He and his colleagues are zeroing in during their research on one of these metabolites. The main reason is that they’re finding this metabolite may offer the same effect of ketamine without any potential for abuse or side effects.

Ketamine Treatment for PTSD

Depression isn’t the only challenge ketamine can play a significant role in—those who are suffering from PTSD can also benefit from its use as well. According to the American Psychiatric Association, “PTSD affects approximately 3.5 percent of U.S. adults, and an estimated one in 11 people will be diagnosed PTSD in their lifetime. Women are twice as likely as men to have PTSD.” Those who have PTSD experience a wide variety of symptoms. Examples of these debilitating symptoms may include:

  • depression
  • flashbacks
  • hyperarousal
  • hypervigilance
  • nightmares

Scientists are working diligently to understand why traumas affect some so severely and while others survive with little to no effects. That makes PTSD and its symptoms challenging to treat. However, ketamine’s research indicates that it may be the answer to the prevention of PTSD developing.

The San Francisco Veterans Affairs Medical Center is also taking notice of the benefits of ketamine for treating PTSD. According to a news release, “A 2-year-old program at the San Francisco Veterans Affairs Medical Center offers ketamine infusions to military veterans who suffer from post-traumatic stress disorder and depression but have not responded to first, second, and third lines of treatment.”

Professionals administer ketamine intravenously at sub-anesthetic doses (0.5 mg/kg), which makes it safe to use in outpatient settings with minimal side-effects. One of the most significant benefits for the use of ketamine for treating PTSD is patients will experience a response within hours, instead of having to wait weeks like with oral treatments. Research states, when a single ketamine infusion occurs, a rapid reduction in PTSD symptoms can occur. This research further indicates that, if the patient is going to respond favorably, the physician and patient will both know following one to two infusions.

The majority of patients respond well to ketamine treatments for PTSD. Therefore, they will likely have a treatment plan that involves setting up a two week series of sessions that could consist of up to six treatments.

Treating depression

Ketamine Treatment for Bipolar Mood Disorder

Previously referred to as manic depression, bipolar disorder is a widely misunderstood condition that is marked by extreme mood swings. These mood swings can include mania or hypomania (emotional highs) and depression (emotional lows). The Depression and Bipolar Support Alliance highlight statistics that this disorder is affecting nearly 5.7 adult residents of the United States or almost 2.6% of the population annually. It can take up to eight years before a patient receives a correct diagnosis from the time of the first episode, suggests Kay Redfield Jamison, a professor of psychiatry at the Johns Hopkins School of Medicine.

In 2015, C. Sophia Albott and her colleagues published, “The Effect of Repeated Ketamine Infusion over Facial Emotion Recognition in Treatment-Resistant Depression: A Preliminary Report. Journal of Neuropsychiatry.” In this study, subjects were given six ketamine infusions over a 12-day period, which was then followed up with a four-week follow-up. Each participant suffered from a host of depressive issues, including PTSD. The results concluded that the use of ketamine produced favorable results for those suffering from depression and PTSD. Those who had PTSD were at an 80% success rate and depression as at a 93.3% success rate.

Another test was published in 2018 by the Journal of Psychopharmacology involving nine researchers. They aimed to determine the neurocognitive effects of six ketamine infusions in patients with bipolar and unipolar depression. They already knew that ketamine is proven to have rapid and positive effects for those who have treatment-resistant depression. However, it was unclear to them if short or long-term impairments would occur if repeated ketamine injections were administered.

Their findings show that over 12 days with 84 participants, they found significant improvements regarding verbal learning and speed of processing. The study’s results show that the improvements in verbal learning and speed processing, “were both significantly mediated by change in depressive symptoms. Logistic regression analysis showed ketamine responders had better visual learning at baseline than non-responders.”

Dena Roland told Kristin Canning of Women’s Health, “I’ve had about 35 treatments over the last three years, and I don’t plan to stop. I’ve been able to stop taking most of my other depression, anxiety, and sleep medications. It’s improved my marriage, I’m able to be there for my daughter like never before, and I’m highly motivated and own my own business now. Things that would have made me crumble in the past, like my dad’s bypass surgery, don’t—I’m able to handle them.”

Ketamine Treatment for Chronic Pain

When you’re used to having free-mobility, experiencing chronic pain is debilitating, painful, and frustrating. The Center for Disease Control (CDC) reports that 50 million Americans are currently suffering from chronic pain. That statistic is a sobering reality, especially when you’re not responding to any treatment method you and your doctor are trying. Chronic pain can also be a major contributor to depression, since it may keep you from working and can make even daily activities difficult. Feelings of vulnerability and hopelessness can lead to depression. As a consequence, treating chronic pain will also help with these depressive feelings as you are able to get back to a life more full of activity. 

Ketamine has been used medicinally for more than 50 years. It’s played a significant role in surgical settings, as well as hospital rooms across the globe. Recently, physicians are paying closer attention to its benefits for chronic pain management as well. Ketamine battles pain by acting against a specific chemical receptor referred to as the NMDA or n-methyl-D-aspartate.

Several studies have shown ketamine is effective for playing a successful role in managing chronic pain for those suffering from:

  • cancer pain
  • complex regional pain syndrome (CRPS)
  • fibromyalgia
  • headaches or migraines
  • ischemic pain
  • peripheral neuropathic pain
  • spinal cord injury pain

In 2018, the first-ever chronic pain management guidelines using IV ketamine were released and printed in the Regional Anesthesia Pain Medicine journal. These guidelines were developed in partnership by the American Academy of Pain Medicine, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists.

“Ketamine has found an expanding role in the treatment of a number of chronic pain conditions, psychiatric uses for depression and post-traumatic stress disorder (PTSD), and for the most challenging acute pain scenarios in awake, non-anesthetized patients,” said Eugene R. Viscusi, MD, a professor of anesthesiology, the chief of pain medicine at Sidney Kimmel Medical College at Thomas Jefferson University, in Philadelphia, and a member of the editorial advisory board for Pain Medicine News.

Evidence also suggests that, for chronic pain, patients who receive higher doses of ketamine over a more extended period at a more frequent dosing schedule show more favorable results. Barby Ingle, a columnist for the Pain News Network, writes, “I began receiving ketamine infusions in 2009. They put me into remission, and I continue with booster therapy as needed. I still have flares, but ketamine got me through the biggest challenges of living with RSD.”

What is Esketamine (Spravato)?

Esketamine, a chemical form of ketamine, is clinically shown to be an effective therapy for those who have treatment-resistant depression. Nearly all individuals who receive a diagnosis for depression, nearly 30% of them have treatment-resistant depression.

For those who are wondering if esketamine is different than ketamine, they’re mostly the same according to Dr. Dan Isoifescu of NYU Langone Health. He writes, “Esketamine is essentially ketamine. Ketamine is a combination of esketamine and r-ketamine…for all practical purposes, there may be slight differences, but it’s the same molecule, just differently wrapped up. 99.9% of everything you say about ketamine is what you would say about esketamine.”

The Food and Drug Administration (FDA) approved the nasal spray, esketamine, on March 5, 2019, for depression. When standard treatments don’t work for patients, esketamine may be the best alternative. According to a news release issued by the American Psychiatric Association on May 20, 2019, “New research supports the effectiveness and safety of esketamine nasal spray in treating depression in people who have not responded to previous treatment.”

Esketamine differs from traditional oral antidepressants because it’s a nasal spray that’s administered in a physician’s office or clinic. It’s currently being marked under the brand name, “Spravato.” Following short-term clinical trials, it’s effectiveness was evaluated, and then one long-term clinical trial was conducted. The FDA determined that esketamine’s benefits outweigh any risks that were found. The main reason is that there’s a growing need for a new drug to address treatment-resistant depression.

Each time a patient uses the nasal spray, they receive a 28 mg device that delivers two sprays. The device must be used with supervision. It’s not currently available for home use. According to the conditions of the approval received from the FDA, patients must use the nasal spray in a clinic or doctor’s office.

Treatment resistant depression

Treating Treatment-Resistant Depression

Those who have received treatment for their depression without favorable results may be suffering from treatment-resistant depression. It may be possible to feel relief by taking an antidepressant or using natural remedies. You may also be able to make some lifestyle changes or undergo counseling to ease symptoms as well.

However, standard treatments aren’t enough for those who are experiencing treatment-resistant depression. Under most circumstances, these methods don’t work, don’t help much, or your symptoms return after you experience improvement.

“Treatment resistance in depression is a major issue, with more than half of patients not responding adequately to standard, appropriate antidepressant treatment,” says Maurizio Fava, MD, executive director of the Clinical Trials Network & Institute in the MGH Department of Psychiatry.

If your primary doctor or therapist has prescribed you an antidepressant without any success, consider asking them to refer you to a professional who specializes in alternative treatments. This opportunity will help you understand new approaches to treating your symptoms.

These professionals will review your medical history, ask you questions about your lifestyle, look at your current diagnosis, assess your medications, and address why you may be treatment-resistant. Then, they may suggest the use of ketamine infusion therapy. A study conducted by the American Journal of Psychiatry concludes that single, repeated infusions of ketamine for treatment-resistant patients show favorable results.

When patients receive ketamine intravenously, the treatments take 60 minutes. However, it’s benefits are noted to last much longer. For example, a single dose of ketamine can continue having effects on a patient for up to seven days with unipolar treatment-resistant depression. However, those who are diagnosed with bipolar depression could experience the effects for between three and four days.

A new study examined by MD Magazine indicates that, when patients have treatment-resistant depression, ketamine infusions are, “associated with continued and maintained reductions in depressive symptoms.” The study involved a team of researchers led by Jennifer L. Phillips, Ph.D., an associate scientist in the Mood Disorders Research Unit at the Royal’s Institute of Mental Health Research.

Forty-one participants were involved in the study, whereby they received three ketamine infusions weekly. Patients who received a single infusion of ketamine reported experiencing a significant reduction in their symptoms of depression following 24-hours.

Other Treatments for Depression

Treating depression isn’t limited to taking oral medications or supplements or making lifestyle changes. If you’re treatment-resistant, trying everything is a priority for easing symptoms. There are many alternatives available if you have an open mind and are willing to commit.

Talk Therapy

A variety of talk therapy methods are available for helping to relieve and ease depression symptoms. Depression often has links to interpersonal relationships, so interpersonal therapy is successful for many. When individuals need to change their behaviors or mindsets that reinforce their feelings of depression, they benefit from cognitive behavioral therapy. There are also therapy sessions featuring less structure, like client-centered therapy, whereby the approach places the majority of the focus on the patient.

Acupuncture

Even though the idea of using dozens of needles is a scary thought to some, the method is successful in treating depression in many cases. Acupuncture is a technique whereby fine needles are tapped into specific areas of the body. You can find studies outlining the use of acupuncture for depression.

Neuromodulation Depression Treatments

In addition to or instead of lifestyle changes, standard treatments, or natural treatments, neuromodulation depression treatments may be used. These treatments are used to treat depression by modifying the brain when stubborn cases present. With the help of computers, treatments include:

  • Electroconvulsive Therapy
  • Neurofeedback
  • Transcranial Magnetic Stimulation (TMS)
  • Transcranial Direct Current Stimulation
  • Vagus Nerve Stimulation

A Well-Balanced Diet

Can a well-balanced diet affect and help to manage depression?  According to an article from Harvard Medical School about Diet and Depression, it can.  The gist of it is, eat plants, and lots of them, including fruits and veggies, whole grains (in unprocessed form, ideally), seeds and nuts, with some lean proteins like fish and yogurt. Avoid things made with added sugars or flours (like breads, baked goods, cereals, and pastas), and minimize animal fats, processed meats (sorry, bacon), and butter. Occasional intake of these “bad” foods is probably fine; remember, everything in moderation. For those who are trying to lose weight, you can’t go wrong with colorful fruits and veggies. No one got fat eating berries or broccoli. Quality matters over quantity. And when it comes to what we eat, quality really, really matters.

Self-Help Books

If you’re not suffering from significant depression symptoms, you may be able to find answers in self-help books. Some of the same skills that are used in therapy sessions and support groups are written about in self-help books. However, reading these books require you to apply this information to your life.

Health-Centered Therapy

It’s possible to see improvements in depression when patients make changes to the amount of exercise they participate in daily. They can also find relief when taking steps toward reducing their stress, ensuring they’re receiving proper nutrition, and sleeping well. Those who are suffering from mild forms of depression may benefit from increasing their exercise instead of using an antidepressant.

Support Groups

Those who aren’t benefiting from one-on-one sessions may find a group setting more rewarding. These groups allow you to hold discussions with other individuals who relate to your symptoms. Many in attendance offer reassurance that you’re not alone provide ideas for what to do next and will help with finding resources.

Problem-Solving Therapy

When patients undergo this form of treatment, they’re working diligently toward viewing problems constructively instead of as a threat. They’re presented with the necessary tools they need to approach the issues they encounter in their daily lives and learn how to solve them. Previously they may have believed they were incapable or unable to solve them. The therapist will help with creating a definition of the problem, brainstorming solutions, developing a solution, and implementing a workable strategy.

Relaxation Techniques

As a way of reducing stress and helping with depression symptoms, relaxation techniques are beneficial. Examples of relaxation techniques include meditation, guided imagery, practicing yoga, breathing exercises, biofeedback, hypnosis, or massage. According to authors from the Cochrane Database of Systematic Reviews 2008, “Relaxation techniques were more effective at reducing self‐rated depressive symptoms than no or minimal treatment. However, they were not as effective as psychological treatment.”

Wrapping it Up

There’s a lot of information regarding the treatment of depression and, if you believe you’re suffering from it, now is the time to find answers. Instead of living with the symptoms, receiving treatment is your best option. If you are looking for Ketamine for Depression in Los Angeles please give us a call.

For more information about using ketamine for depression, contact Pacific Ketamine Institute today.

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