Everything you Need to know about Ketamine Treatment for Depression

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Ketamine was introduced in the 1960s as an anesthesia medicine for soldiers on the battlefields during the Vietnam War. Today, ketamine is only legal and administered via a prescription and is used in veterinary medicine during surgery. 

It is a Schedule III drug according to the Drug Enforcement Administration (DEA), which means that it has medically accepted uses but also has potential for abuse, including physical and psychological dependence.

Ketamine is a dissociative anesthetic, meaning that it changes the individual’s perception of sight and sound and creates feelings of detachment from the environment (dissociative) while simultaneously relieving pain (anesthetic).

Ketamine is also classified as a hallucinogen. However, ketamine is very loosely defined as a hallucinogen because the class of hallucinogens also includes drugs like lysergic acid diethylamide (LSD), salvia, peyote, phencyclidine (PCP), and psilocybin (mushrooms).

Ketamine, when administered as a prescription, has the potential to treat post traumatic stress disorders (PTSD), treatment-resistant depression, anxiety, and both chronic and severe pain. 

Ketamine as an Illegal Drug

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Ketamine serves a purpose in medicine when prescribed correctly, but it is also a commonly abused drug. Commonly referred to as “Special K” and “Cat Valium,” Ketamine is sold illegally as a mind-altering drug that enhances or alters mood and perception.

The anesthetic properties can also cause the individual to feel numb, which may lead to accidents and severe injuries while under the influence of ketamine.

Usually, the “high” lasts for less than an hour and can cause a state of utter bliss, also known as euphoria. In addition to the typical “out of body experience,” higher doses that are typically injected can lead to an effect known as the “K-hole.”2

“K-hole” refers to a near-death, out-of-body experience, where the user is incapable of interacting with others. 

Treatment-Resistant Depression

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Approximately 30% of individuals with major depressive disorder experience symptoms that do not improve with treatment.3 An individual, who does not improve with two different depression medications of adequate doses taken for at least six weeks in duration, is said to have treatment-resistant depression.

It is difficult to determine who will have treatment-resistant depression, but research has shown that female gender and older age are risk factors for treatment-resistant depression.

Individuals who have chronic medical illnesses such as chronic pain and thyroid disorders are also at an increased risk for treatment-resistant depression and individuals who have a history of eating disorders, substance abuse disorders, and sleep disorders.

There are effective treatment options that do work to treat this type of depression, as well as new research in the pipeline. 

Ketamine as a Treatment For Depression

The Food and Drug Administration (FDA) approved Ketamine, under the name esketamine (called “Spravato” by the manufacturer) for treatment-resistant depression in the spring of 2019.

Ketamine has been used as an off-label drug to treat this type of depression for years before the FDA approved it. Ketamine does not target the same brain activities as antidepressants like fluoxetine (Prozac), venlafaxine (Effexor), and sertraline (Zoloft). Rather, it blocks a receptor called N-methyl-D-aspartate, or NMDA.

Researchers are still not certain why some people with depression respond to ketamine and others do not. Still, without FDA approval, this drug has been used for “off label” uses in individuals with treatment-resistant depression, pain management, and palliative care.4

Before ketamine was FDA-approved for treatment-resistant depression, ketamine was administered intravenously. Following its approval by the FDA, individuals can administer it themselves as a nasal spray under medical supervision.

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