Ketamine and depression
One out of five persons suffer at least one episode of depression in the course of their lives, and half of those several episodes. This leads to a marked reduction in the joy of living and quality of life. The optimal treatment includes psychotherapy, drug therapy and, if necessary, other therapeutic measures. However, 50% of patients do not benefit from the medication. In addition, side effects such as weight gain, drowsiness and sexual dysfunction are not uncommon. For several years now, more and more studies have proven the effectiveness of ketamine in treating depression.
Ketamine is a drug that has been known for over 50 years and is usually used to initiate and perform general anaesthesia, analgesia and anaesthesia in emergency medicine as well as short anaesthesia for painful interventions. In the group of anaesthetics, it occupies a special position due to its dissociative effect: in this group of anaesthetics, the patient is unconscious, does not feel any pain, but the eyes may be open, the protective reflexes and the independent breathing are maintained. Especially in the waking up phase, nightmares and hallucinations may occur.
In recent years, it has been found that ketamine has an excellent antidepressant and anti-suicidal effect in many patients with severe depression. Several studies have shown that the effect is better and quicker than that of conventional antidepressants. Whereas less than half of the patients with conventional antidepressants experienced an improvement of their symptoms after about 6 weeks, the ketamine infusions were able to improve more than half of the patients, the beneficial effects starting after few days.
Patients receive a total of 6 infusions of ketamine over a period of 2-3 weeks. Afterwards, stabilisation infusions at longer intervals could be useful.
The dose administered is significantly lower than that of pain therapy or anaesthesia. In addition, the ketamine is not administered within seconds or a few minutes, but over a period of 45 minutes. That’s why the side effects are very small: many patients experience a feeling of lightness, detachedness or tingling in the extremities after a few minutes. Serious side effects or a dependency are not to be expected in professional use.
Vehicles and machines may not be operated for 24 hours after an infusion.
IMPORTANT: Ketamine is not currently approved by the Medicines Agency to treat depression. Ketamine infusions for the treatment of depression are therefore an „off-label“ use. For other purposes, however, it is a widely used drug. The health insurance companies do not cover the costs of such a treatment. Therefore, after a detailed consultation in which we checke whether a ketamine infusion therapy can be of benefit to the patient and in which risks and side effects are discussed in detail, the patient must sign an agreement form.
In the emergency room and as an emergency doctor I use ketamine regularly. The numerous studies, which prove the good effect of ketamine, especially in patients who have not been able to experience any relief of their suffering from other antidepressors, convince me to offer you this therapy option in our practice. Talk to us about it.
Areas of application of ketamine-infusions
- Some chronic pain conditions: neuropathic pain, diabetic polyneuropathy, fibromyalgia
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- Curr Neuropharmacol. 2014 Sep;12(5):444-61. The role of ketamine in treatment-resistant depression: a systematic review.
- Biol Psychiatry. 2016 Sep 15;80(6):424-31. Intravenous Esketamine in Adult Treatment-Resistant Depression: A Double-Blind, Double-Randomization, Placebo-Controlled Study.
- Am J Psychiatry. 2013 Oct;170(10):1134-42. Antidepressant efficacy of ketamine in treatment-resistant major depression: a two-site randomized controlled trial.
- Un anestésico para caballos alivia la depresión en horas, según un estudio
- La ketamina, la ‘droga de las raves’, último recurso contra la depresión
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