Nicole Bayman had battled depression unsuccessfully for nearly her whole life, trying dozens of antidepressants, attending therapy, and even receiving in-patient treatment in a hospital. About six months ago, she learned from her therapist about ketamine, a prescription medication that’s approved for use in hospitals and other medical settings as an anesthetic and is now gaining widespread attention as a treatment for depression. Soon after she began receiving regular infusions of ketamine, Bayman says, the depression began to lift.
“I feel like a different person,” says Bayman, an attorney who lives in Princeton, New Jersey. “It’s as if there were a veil over me and the veil was lifted. Before I started to receive ketamine, I could barely get out of bed. Now I can walk my walk and re-engage in life.”
Bayman is not the only individual suffering from depression whose symptoms improved dramatically while on ketamine. Although it’s been abused in the past as a “recreational drug” because of its hallucinogenic and tranquilizing effects (known on the street as “Special K”), today ketamine is drawing a lot of positive attention because it is being used “off-label” to treat treatment-resistant depression—and patients are happy with the results. (When a drug is “off label,” it’s being used to treat a condition in a way that has not been approved by the US Food and Drug Administration.)
Steven Levine, MD has treated more than 3,000 patients with ketamine since it opened in 2011. Worldwide, he says, 10-15,000 patients have been treated with ketamine. Dr. Levine says that ketamine is an excellent medication to use for depression. But why would someone ultimately turn to ketamine when there are other, FDA-approved, antidepressants available?
“We have a crisis going on today and the traditional medications for depression aren’t very effective,” Dr. Levine says. “While ketamine is not FDA-approved for depression, 70% of the medications prescribed today are ‘off label’ for at least one use.” Commonly-prescribed antidepressants are also rarely fast-acting—taking weeks or months before a patient experiences any relief from the debilitating symptoms of depression. They can also cause nausea, drowsiness or insomnia, and constipation. Additionally, weight gain—which is associated with commonly-prescribed anti-depressants—is NOT a side effect of ketamine,” Dr. Levine says adding that its fast-acting nature may be the most important feature of the medication.
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Ketamine vs. SSRIs
All too often, Dr. Levine says, the traditional medications prescribed for depression are either not fast-acting enough or effective enough. “Ketamine is an effective alternative for some patients,” he says. “It works differently from an SSRI such as Lexapro or Zoloft. It’s a totally different mechanism.”
The classical “shorthand” explanation for how SSRIs work is the “chemical imbalance” theory, Dr. Levine explains. “There is a deficit of serotonin, and SSRIs increase serotonin levels,” he says. “That was never really true. Depression is linked to the build-up of proteins in the brain—ketamine can repair damage to the brain that are the result of long-term stress hormones. The body’s response to stress spills cortisol and other hormones in the brain and they damage it in the process.” Ketamine, Dr. Levine says, “is thought to have much more rapid effects on increasing brain plasticity.”
Molly Shea, 29, a veterinary technician, first learned about ketamine from a co-worker. Molly had been struggling with depression since seventh grade when she was relentlessly bullied at school. She had been counseled by numerous therapists and psychiatrists, tried a variety of traditional antidepressants, and been in and out of in-patient and intensive treatment facilities over the years. Molly had developed panic attacks and gone through periods of suicidal thoughts and self-harming. “I was at the point of considering ECT (electroconvulsive therapy—a form of neurostimulation involving electrical impulses) because nothing was helping me and we were running out of options.” When she asked her psychiatrist about ketamine, he put her in touch with Dr. Levine who started Molly’s treatments in August. “I am feeling the best I have felt since all my depression began. I’m coping with life much better than I was,” Shea says.
What Does a Ketamine Treatment Consist of?
Rather than being a first-line treatment, Dr. Levine says, ketamine is given when other antidepressants don’t work. It’s administered by an IV infusion in the arm, and typically the effects last for anywhere from days to weeks. “Generally, it’s administered in a tapering sequence in which patients receive three infusions the first week, two in the second week, once weekly for the next three weeks, and then moving to maintenance of, on average, once per month,” Dr. Levine says.
Ketamine has also been used in cases of bipolar disorder, but it is not indicated for patients with active psychosis, mania, or unstable cardiovascular disease, Dr. Levine says. Nor is it indicated in children, he adds.
Providing Help for Veterans
In addition to depression, ketamine may ease the post-traumatic stress disorder (PTSD) that many veterans experience. PTSD, a mental health problem that people can develop after experiencing some type of trauma, such as combat, can be treated effectively with ketamine, says Aimee Cabo Nikolov, BSN, who with her husband, Boris, runs the Ketamine Medical Clinic, a division of the Neurosciences Medical Clinic, in Miami. “Some researchers have called ketamine the most important discovery in half a century,” Nikolov says, adding that about 35% of the patients in their clinic are military veterans seeking treatment for PTSD. “For many veterans suffering from PTSD, ketamine is providing hope after other kinds of treatment didn’t give them the results they needed,” Nikolov says.