Ketamine Depression Treatment in LWR

Ketamine was once primarily used as a battlefield and operating room anesthetic. Now, this drug is gaining momentum as a potential cure for some instances of major depression, the world’s leading cause of disability. According to new figures, 16 million people in the United States had a major depressive episode in the previous year. Between 1999 and 2016, the number of people who committed suicide increased by more than 30 percent in 25 states. Ketamine may have a role to play in preventing suicide because of its swift action.

Why is Ketamine so appealing as a treatment for depression?

If a person reacts to Ketamine, it can reduce and minimize suicidality (death-inducing thoughts and actions) and other severe depression symptoms rapidly.   Ketamine is also helpful in the treatment of depression and anxiety.

Other therapies for suicidal thoughts and depression may take weeks or months to work, and some patients will need to try several drugs or interventions before finding relief. This is true of talk therapies, antidepressant medications, transcranial magnetic stimulation (TMS), and electroconvulsive therapy (ECT).  Ketamine treatment is the only intervention that can actually eliminate suicidal thinking independently of other symptoms.

What form of Ketamine is Available at Synergy Medical?

Racemic ketamine, or IV Ketamine, is the form in our clinic, and administered as blood infusion. It’s made up of two mirror-image ketamine molecules: “R” and “S” ketamine. While the FDA licensed it as an anesthetic decades ago, it is now used off-label to treat depression.

How does Ketamine work for Depression?

Ketamine’s mechanism of action isn’t fully understood. Ketamine could help people better handle depression where other therapies have failed because it exerts an antidepressant effect through a novel mechanism.

NMDA receptors in the brain are one of ketamine’s most likely targets. Ketamine tends to increase a neurotransmitter called glutamate in the spaces between neurons by binding to these receptors. Glutamate then stimulates interactions in the AMPA receptor, which is a different type of receptor. The initial blockade of NMDA receptors and activation of AMPA receptors together result in the release of other molecules that assist neurons in interacting with one another along new pathways. This mechanism, known as synaptogenesis, is thought to affect mood, thought patterns, and cognition.

Ketamine can also have other effects on depression. It may, for example, minimize inflammation-related signals, which have been connected to mood disorders or enhance connectivity within specific brain areas. Ketamine most likely acts in several forms simultaneously, all of which are currently being investigated.

What are the potential Ketamine Side Effects?

There are side effects with any drug. Possible benefits can outweigh potential risks when someone is suicidal or seriously depressed.

Infusions of ketamine can cause:

  • blood pressure that is too high

  • vomiting and nausea

  • perceptual alterations (time appearing to speed up or slow down; colors, textures, and noises that seem incredibly stimulating; blurry vision)

  • dissociation (also known as out-of-body experiences); a person can, for example, feel as though they are looking down on their body.

Any changes in perception or dissociation are usually most apparent during the first infusion and disappear rapidly afterward.

What else should you know when it comes to IV Ketamine?

Compared to the dosage required for anesthesia, a much lower dose of ketamine is provided for depression.  You will be awake during the treatment. Your Ketamine infusion will take place in a comfortable private treatment room.  You will remain in your street clothes, so wear something loose fitting.  Our CRNA will conduct an anesthesia patient assessment and evaluation before each infusion. We will start a small IV and connect you to our monitors.  You will relax in a comfortable recliner for the duration of the infusion.   As safety is our priority, our CRNA will remain in attendance throughout your course of treatment.    The process takes between 45 and 55 minutes.  Ketamine infusion therapy has noted side effects including mild hallucinations, visual or auditory sensitivity, headaches, nausea and sedation.  Rest assured we are equipped to control or treat any of these readily, should they arise. 

In most cases, people respond to IV ketamine after the first infusions.  90% of   People who experience some relief from depression after one or three ketamine treatments in Lakewood Ranch are likely to have these beneficial effects continue longer if the procedure is repeated. The protocol at Synergy Medical is 6 infusions over 2 weeks.

If you need any medical clearances, such as those from a cardiologist, pulmonologist, or GI specialist, they will be obtained before treatment begins.