Ketamine for Depression
Depression is the leading cause of disability in people between the ages of 15 –44. Major depression is a common debilitating disorder affecting 10%–15% of the population per year. Despite advances in the understanding of the psychopharmacology and biomarkers of major depression and the introduction of several novel classes of antidepressants, only 60%–70% of patients with depression respond to antidepressant therapy.
Of those who do not respond, 10%–30% exhibit treatment-resistant symptoms coupled with difficulties in social and occupational function, a decline in physical health, suicidal thoughts, and increased health care utilization. According to the findings from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, 50%–66% of patients with depression do not recover fully on antidepressant medication and one-third of patients do have a remission of their depressive symptoms.
Scientists think that in people with clinical depression, certain neurotransmitters may be out of balance. One option for treating depression is prescription drugs that affect the levels of certain chemicals that brain cells use to communicate, called neurotransmitters. These options are sometimes called antidepressant medications. Some types of antidepressant medications that are available include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs).
These medications affect levels of serotonin, among other neurotransmitters to produce their effect. Other options for treatment include psychotherapy, Transcranial Magnetic Stimulation (TMS), and ECT (Electroconvulsive therapy).
Despite these advances, many therapies do not work well in a significant percentage of the population and produce their effectiveness very slowly. In a landmark 2000 study published in Biological Psychiatry, Robert Berman and colleagues at the Yale School of Medicine demonstrated that ketamine had quick-action antidepressant properties on people with treatment-resistant depression.
Further investigations by Carlos Zarate showed that a single infusion of ketamine produced robust improvement in depression in 71% of the test subjects and remission in 29%. Further work by Carlos Zarate using was showcased in the JAMA 2017 article in which the ketamine experience of rapid antidepressant effects was reviewed in an interview.
Ketamine has produced rapid reductions in depression in treatment-refractory patients in numerous studies and has performed well when other interventions had minimal impact. This has been experienced in our ketamine center as well. For more information, links to ketamine in the media are available to download:
Ketamine for PTSD
Post-traumatic stress disorder (PTSD) is a chronic and disabling condition arising after exposure to a severe traumatic event, characterized by persistent reexperiencing, avoidance, and hyperarousal symptoms. In the general population, prevalence has been estimated at 7.8%, with higher rates in trauma-exposed populations, particularly among survivors of interpersonal violence. Standard therapies used in depression do not work for PTSD, including selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and other medications. These treatments are associated with significant levels of nonresponse and persistent residual symptoms in the few that do respond.
One of the first randomized trials demonstrating ketamine’s effectiveness in PTSD was in a study by Dr. Feder in June 2014. The study was designed after the recognition that a medical record review of a large sample of burned servicemembers found a significantly lower prevalence of PTSD among patients who received ketamine during post-trauma surgical procedures than among those who did not. This study demonstrated significant improvements in multiple domains in PTSD symptoms and depression that lasted several weeks and beyond. Ketamine has been shown to rapidly increase the number and function of synaptic connections in the prefrontal cortex, rapidly reversing behavioral and neuronal changes resulting from chronic stress and trauma-related memories. This data provided the first randomized, controlled evidence that NMDA receptor modulation could lead to the rapid clinical reduction of core PTSD symptoms in patients with chronic PTSD
Here are some symptoms of PTSD that you can use to screen you or your family members:
Persistent avoidance of distressing memories, thoughts, or feelings about or closely associated with the traumatic events or of external reminders (i.e., people, places, conversations, activities, objects, situations)
Two or more of the following:
- Inability to remember an important aspect of the traumatic events (not due to head injury, alcohol, or drugs)
- Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous”).
- Persistent, distorted blame of self or others about the cause or consequences of the traumatic events
- Persistent fear, horror, anger, guilt, or shame
- Markedly diminished interest or participation in significant activities
- Feelings of detachment or estrangement from others
- Persistent inability to experience positive emotions
Two or more of the following marked changes in arousal and reactivity:
- Irritable or aggressive behavior
- Reckless or self-destructive behavior
- Exaggerated startle response
- Problems with concentration
- Difficulty falling or staying asleep or restless sleep
Also, clinically significant distress or impairment in social, occupational, or other important areas of functioning not attributed to the direct physiological effects of medication, drugs, or alcohol or another medical condition, such as traumatic brain injury.
If you or a loved one is suffering from these symptoms, seek help from a therapist if you have not done so already. Ketamine infusions are an excellent choice to help control your symptoms to gain back your life.
Ketamine for OCD
Obsessive-compulsive behaviors, commonly referred to as OCD, begin as incessant thoughts that lead to unstoppable, irrational impulses to do things such as repeatedly wash hands, check locks, and other futile activities used to reduce feelings of anxiety.
Common Symptoms of OCD
obsessive hygiene or cleanliness
need for object alignment
repetition of routine or behavior
concern of potential damage
compulsive behaviors or thoughts
Unfortunately, the many medical treatments and psychotherapy interventions fail to improve many of these symptoms leaving patients with little hope and much depression. Ketamine, though its ability to diminish intrusive thoughts, may be a significant game-changing intervention for OCD sufferers while they apply other traditional therapies to their condition.
Ketamine: Fresh hope for the treatment of OCD Stanford Medicine Scope
Ketamine Rapidly Reduces OCD Symptoms Psych Congress
Ketamine Is Showing Early Success With Treating OCD Tonic
Rapid Resolution of Obsessions After an Infusion of Intravenous Ketamine in a Patient with Treatment-Resistant Obsessive-Compulsive Disorder: A Case Report
Glutamate-Modulating Drugs as a Potential Therapeutic Strategy in Obsessive-Compulsive Disorder
Ketamine for Chronic Pain
Ketamine has been used for pain control and sedation in the Emergency Department setting for many years. It allows patients to dissociate pain from any emotional content and at higher doses can place patients in the “K-hole” in which they are able to carry out their vital body functions, such as breathing, but are unable to feel any pain or recall it.
Ketamine infusions and topical formulations have been used to treat many painful conditions with excellent success rates where standard pain medications have failed. Patients with complex regional pain syndrome (CRPS), for example, can respond extremely well to ketamine infusions. Traditional medication approaches, including opioids, have had much less success in this treatment. Our center has utilized ketamine for CRPS, neuropathies, fibromyalgia, phantom limb pain, and post-herpetic zoster pain syndromes with much success. We also formulate topical therapies that include ketamine for painful conditions that follow local nerve damage, such as shingles.
NOVA Health Recovery also continues care with pain management as needed, including trigger point injections, joint injections, and continued medication management as well. Call today for an evaluation of your condition to relieve your suffering at 703-854-9608.
Resources for pain management and ketamine treatment:
Ketamine for Anxiety & Social Phobia
- Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18 and older, or 18.1% of the population every year.
- Anxiety disorders are highly treatable, yet only 36.9% of those suffering receive treatment.
- People with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those who do not suffer from anxiety disorders.
- Anxiety disorders develop from a complex set of risk factors, including genetics, brain chemistry, personality, and life events.
- General anxiety disorder affects 6.8 million adults or 3.1% of the U.S. population, yet only 43.2% are receiving treatment. Women are affected more than men, and GAD often co-occurs with depression.
The continual suffering from anxiety and social phobias results in lost days at work, less life satisfaction, depression, suicidal thoughts, and addiction in many. Alcohol and opioids can become a social lubricant allowing one to cope with the struggles of day-to-day panic attacks and stress. For others, the constant need for medications to treat the disorder that seems to still push through can be disabling.
We have found that ketamine infusions and treatment with other off-label approaches can help significantly reduce symptoms of anxiety, social phobia, and depression. Periodic infusions can be used to maintain effectiveness after the initial successful therapies. We do like to evaluate patients’ biochemistry and genetic profiles in more integrative ways to suggest nutraceutical and nootropic options to lessen symptoms. In some, home prescriptions of intranasal or oral ketamine with oxytocin have been an effective strategy, while in others, IV vitamin therapies with additional micronutrient treatment have made a significant change in patient’s stress and anxiety. We do investigate methylation issues in your genetics to determine more integrative ways to manage the formation of dopamine (the reward molecule) and serotonin levels (the happiness molecule) that can make you feel better. These same strategies are effective for aiding your sleep patterns as well – insomnia goes hand in hand with anxiety and depression.
Ketamine Effective as Maintenance Treatment for Anxiety psych congress April 2018
Glue P, Neehoff SM, Medlicott NJ, Gray A, Kibby G, McNaughton N. Safety and efficacy of maintenance ketamine treatment in patients with treatment-refractory generalized anxiety and social anxiety disorders. Journal of Psychopharmacology. 2018 March 21;[Epub ahead of print].
Maintenance ketamine may offer an alternative for patients with treatment-refractory anxiety disorders. Psychiatric News Alert. March 29, 2018.
Ketamine Effects on EEG during Therapy of Treatment-Resistant Generalized Anxiety and Social Anxiety International Journal of Neuropsychopharmacology 2018
The anti-anxiety effects of ketamine are linked to changes in theta brainwaves Psy Post 2018