What is Ketamine?

Hope for Healing Behavioral Health Center offers Ketamine treatments for treatment resistant depression.  Once ordered by a prescriber, ketamine is infused by licensed ICU nurses and nurse anesthetists.

WHAT IS KETAMINE

Ketamine is a dissociative anesthetic that has been around since the 1960’s.   It has proven very safe.  It distorts perceptions of sight and sound and makes a person feel disconnected from their pain, anxiety, depression, and their environment while it is being administered.  Low dose Ketamine can induce a state of sedation (feeling calm and relaxed).  Its lasts a short time approximately 30 to 60 minutes.

Here is what some people have said:

“It was spiritual for me.  I felt that I was with God and I felt an overwhelming sense of peace and love.  This made me feel like everything was going to be OK.”  -Jaime 4/8/2021

“While I was under the influence of ketamine, I felt like I resolved a bad break up with someone who had hurt me in the past.  I saw the person in my mind and began to cry, we made up and forgave each other.  It was beautiful.  I didn’t even realize this broken relationship was bothering me until this happened.  I felt so at peace.” -Anne 1/13/2020

“I saw myself as a toddler- wearing torn and dirty clothing, crying and all alone.  My adult self -picked up my child self and hugged her and told her everything would be OK.  I felt loved after the infusion was over.” Caitlyn 3/2/2021

TREATMENT FOR DEPRESSION

People usually take antidepressants for weeks before they might see an effect.  Ketamine is different.  Its effects on depression happen as it leaves your body.  The former director of the National Institute of Mental Health states, “recent data suggest that ketamine, given intravenously, might be the most important breakthrough in antidepressant treatment in decades.” (Insel, 2014).   If a person responds to ketamine, it can rapidly reduce suicidality and relieve other serious symptoms of depression. Ketamine also can be effective for treating depression combined with anxiety.

There are some theories as to how it works:

  • It prompts connections to regrow between brain cells that are involved in mood.  These effects can be profound and works faster than antidepressants (Collins, 2018).
  • Ketamine targets NMDA receptors in the brain. By binding to these receptors, ketamine appears to increase the amount of a neurotransmitter called glutamate in the spaces between neurons. Glutamate then activates connections in another receptor, called the AMPA receptor. Together, the initial blockade of NMDA receptors and activation of AMPA receptors lead to the release of other molecules that help neurons communicate with each other along new pathways. Known as synaptogenesis, this process likely affects mood, thought patterns, and cognition (Aleksandrova et al., 2017).
  • Ketamine may reduce signals involved in inflammation, which has been linked to mood disorders, or facilitate communication within specific areas in the brain (Meisner, 2019).
  • Increased levels of brain derived neurotrophic factor (BDNF), a protein that plays a role in the growth and maintenance of neurons, is involved (Bathina and Das, 2015).
  • A recent study suggests that HDAC5, an enzyme, regulates the antidepressant effects of ketamine through a process called phosphorylation, which regulates protein function. Ketamine increases BDNF levels in the central nervous system which prompts the growth and connections of dendrites on the neurons in the brain (Ketamine, 2019).
  • Research suggests that repeated trauma reduces levels of BDNF in the amygdala, hippocampus, and nucleus accumbens.   Ketamine reverses this damage in the amygdala and nucleus accumbens. This is important because the amygdala plays a critical response in fear and strong emotions, while the nucleus accumbens is essential in motivation, aversion, reward, and learning (Yu and Chen, 2011).

All of these may play a role in decreasing depression, anxiety, and helping people through their traumatic pasts.

HOW IS IT ADMINISTERED

A much lower dose of ketamine is given for depression compared with the dose necessary for anesthesia.  Ketamine is given intravenously, twice per week for three weeks for a total of six treatments.  Each infusion lasts 40 minutes but you will be in the clinic for about 1.5 hours to allow for preparation time and recovery.

SIDE EFFECTS

All drugs have side effects. When someone is suicidal or severely depressed, possible benefits may outweigh the possible risks.

Ketamine given by infusion may cause:

  • high blood pressure
  • nausea and vomiting (although Zofran is given to prevent this)

 

References:

Aleksandrova, Lily R, et al. “Antidepressant Effects of Ketamine and the Roles of AMPA Glutamate Receptors and Other Mechanisms beyond NMDA Receptor Antagonism.” Journal of Psychiatry & Neuroscience : JPN, Joule Inc., June 2017.

Bathina, Siresha, and Undurti N Das. “Brain-Derived Neurotrophic Factor and Its Clinical Implications.” Archives of Medical Science : AMS, Termedia Publishing House, 10 Dec. 2015.

Choi, Miyeon, et al. “Ketamine Induces Brain-Derived Neurotrophic Factor Expression via Phosphorylation of Histone Deacetylase 5 in Rats.” Biochemical and Biophysical Research Communications, vol. 489, no. 4, 2017, pp. 420–425., doi:10.1016/j.bbrc.2017.05.157.

Collins, Sonya. “What Is Ketamine? How It Works and Helps Severe Depression.” WebMD, WebMD, 27 Feb. 2018.

Insel, Thomas. “Post by Former NIMH Director Thomas Insel: Ketamine.” National Institute of Mental Health, U.S. Department of Health and Human Services, 1 Oct. 2014.

Ketamine, Reset. “Ketamine’s Impact on Brain-Derived Neurotrophic Factor (BDNF).” Reset Ketamine – Ketamine Infusion Clinic in Palm Springs, California, Reset Ketamine – Ketamine Infusion Clinic in Palm Springs, California, 1 Nov. 2020.

Lepack, A. E., et al. “BDNF Release Is Required for the Behavioral Actions of Ketamine.” International Journal of Neuropsychopharmacology, vol. 18, no. 1, 2014, doi:10.1093/ijnp/pyu033.

Réus, Gislaine, et al. “Ketamine Treatment Partly Reverses Alterations in Brain Derived- Neurotrophic Factor, Oxidative Stress and Energy Metabolism Parameters Induced by an Animal Model of Depression.” Current Neurovascular Research, vol. 12, no. 1, 2015, pp. 73–84., doi:10.2174/1567202612666150122122924.

Robert C. Meisner, MD. “Ketamine for Major Depression: New Tool, New Questions.” Harvard Health Blog, 20 May 2019.

Yu, Hui, and Zhe-yu Chen. “The Role of BDNF in Depression on the Basis of Its Location in the Neural Circuitry.” Acta Pharmacologica Sinica, Nature Publishing Group, Jan. 2011.