Episode 57 - Ketamine And Depression
Hi there. I'm Diane Carbo with Caregiver Relief. Thanks for visiting with us today. Our website is for caregivers. We know that being a caregiver can be challenging, but we are here to help. Our website is full of useful information that can make your life easier. If you want to stay up to date with our latest content, be sure to subscribe to our email list. And as a subscriber, you'll get access to exclusive content that isn't available to the public. And don't miss out on our great resources we have to offer.
Subscribe now and start benefiting from our expert advice and support. Thanks for watching, and we look forward to supporting you on your caregiving journey. Now, today's lesson is Ketamine and depression. Depression is a serious mental health disorder that can drastically impact how you think, feel, and handle daily tasks, prolonged sadness, hopelessness, and irritability are typical symptoms of this mood disorders, which have been linked to chronic stress in studies with animals leading to communication disruption between neurons in the prefrontal cortex area of the brain to a loss of the dendritic spines. Lot of big words there, isn't it? That just means that there's a breakdown in the communications between the neurons in the front part of our brain. To improve these feelings, it's key to focus on treatment methods such as medications or psychotherapy, sometimes both working together offer effective management techniques for those suffering from the depression symptoms. Despite the success of commonly prescribed antidepressants like selective serotonin, re-uptake inhibitors called SSRIs, many people suffering have yet to find relief in managing their depression. Thankfully, there may be an answer with ketamine therapy. Researchers explored its efficacy of ketamine therapy is a potential solution for treatment resistant depression. The results of those recent studies were featured in the Journal of Effective Disorders. It focused on ketamine in many forms.
Intravenous ketamine, intranasal ketamine, and use taken orally. Significant improvement has shown to provide respite from those suffering from this debilitating condition. Unlike traditional antidepressants, like the selective serotonin, re-uptake inhibitors, antidepressant effects take weeks or longer to deliver positive results.
The rapid action of the drug ketamine can almost have immediate results. It can relieve depressive symptoms in just hours. With new found insight into ketamine short and long-term biological changes, medical professionals now have another tool at their disposal helping them combat one of our most pressing mental health issues today.
Depression. Ketamine for depression. For those dealing with depression, it can be a long road of trial and error to find the right treatment. One in three patients fail to achieve remission after trying multiple antidepressant medications such as fluoxetine.
This is known as treatment resistant depression. I suffer from this. I've gone through all the treatments. I've done everything I possibly could. I know I personally suffer from treatment resistant depression. Ketamine has been studied for its ability to manage treatment resistant depression. Widely used over many years as an anesthetic and painkiller, ketamine offers another option for managing hard to treat depressive symptoms so people can live free and enjoy a better quality of life. I want to first cover the history of ketamine because it has so many misconceptions about it. Ketamine has been around for over a hundred years. It was developed to be used as an anesthetic and painkiller because of its disassociative of effects and hallucinogenic effects. Ketamine of fusions have been used on the battles field to save millions of soldiers. It was a rapid acting drug that allows a person to be treated by causing a disassociative effect as well as relief from pain.
It also has amazing anti-inflammatory properties as well. For decades, ketamine has been used recreationally as a club drug for its disassociative and hallucinogenic effects. Many know ketamine as a drug that veterinarians use for to tranquilize horses.
It was found to have success with those suffering with from mental illness and suicide thoughts. Many first responders have given ketamine treatment to a patient that had suffered some sort of trauma as an attempt to complete suicide.
There was such a significant improvement in such a short period of time that many patients were actually denying any suicide ideation while in the ambulance on the way to the emergency room. Many reported relief from suicidal ideation for months later. So let's talk about ketamine and the possible benefits for other conditions.
Most research is increasingly studying using ketamine therapy to clinically treat other mental health conditions such as anxiety, post-traumatic stress disorder, also known as P T S D, bipolar disorder, unipolar depression, especially in cases where standard treatments have failed. Ketamine comes in a range of forms. R ketamine or R-ketamine, S ketamines, S-ketamine, his intranasal ketamine. Then we have Racemic Ketamine, which contains equal amounts of our ketamine and S ketamine variants. Racemic Ketamine is the form used in Ketamine IV infusion.
You may want to discover the potential benefits that this remarkable drug can bring. So how does Ketamine help with treatment resistant depression? After many years of research development and clinical trials in 2019, the F D A approved ketamine as a treatment for severe major depressive disorder.
The Food and Drug administration has given a new hope to those struggling with major depression. The nasal spray Esketamine is derived from Ketamine. It is now available in an intranasal spray offering benefits for patients who haven't seen improvements through standard treatments. 70% of participants in one clinical study achieved impressive results when taking Esketamine along with their oral antidepressants. Demonstrating its potential to help individuals regain control over treatment resistant depression.
So how does Ketamine work Traditional anti-anxiety drugs? Ketamine stands out as the medication rather than providing a temporary relief in your body like Valium does, it encourages neuroplasticity to create lasting change by triggering reactions throughout your cortex. The brain's ability to regrow necessary brain connections is just incredible. Ketamine encourages that growth. In the 1980s, a remarkable discovery was made that provided new hope for people suffering from major depression.
Through chance observation of drugs used to treat other conditions, it became evident that altering serotonin concentrations could induce significant changes in mood. This was either positive or negative, depending on whether the serotonin levels were raised or lowered. As such selective serotonin re-uptake inhibitors, SSRIs were developed and Prozac became one of the first available medications, providing relief to those afflicted with depression. So let's talk about the history of traditional antidepressants. After initial enthusiasm around the serotonin hypothesis, researchers realized it could not adequately explain depression on its own. The antidepressant effect of these drugs that targeted the serotonin neurotransmitter were found to be of limited help.
In fact, over one third of cases had no antidepressant effects at all. This prompted a further look into how our brains work and what other factors might influence mental health. With that they've discovered GABA, G A B A and N M D A receptors.
Let's talk about that. As research developed, scientists uncovered that GABA, G A B A and glutamate are responsible for up to 80% of brain activity indicating there is an essential role in understanding mood disorders such as severe depression. GABA and glutamate are two powerful neurotransmitters in the brain. N M D A receptors are glutamate receptors. They have been linked to a host of mental health condition. What's interesting is they form an ongoing interaction, a communication, if you will, between brain cells between one another, which can spark electrical activity or stop it in its tracks, making them responsible for much of our mood regulation. Yet things can get even more complex. Chronic stress can disrupt how these neurotransmitters communicate with neurons causing difficulties adapting to negative events, creating a cycle where life becomes increasingly hard for those dealing with difficult emotions.
Yale School researchers uncovered something amazing. Studies reveal that when patients are given the drug ketamine, their brains actually form new neural connections. This allows people to become more adaptable and develop positive behaviors. A capability not seen with traditional antidepressants alone.
In fact, this discovery came about because of a suspicion. Researchers thought there might be abnormalities within certain brain systems in those experiencing depression. So they sought out ways to target these areas specifically through medication. For two decades, Yale school researchers have been blazing a trail in Ketamine's research. Lower doses of ketamine were delivered intravenously to those suffering from severe depression. These candidates have had no response to more traditional treatments. Yale school researchers saw remarkable results.
More than half of their patients report significant symptom relief in as quickly as 24 hours. An incredible result for those who found no help elsewhere. So how do we make ketamine a part of a comprehensive treatment plan? People with depression should approach ketamine as part of a holistic treatment plan. While it may provide significant decrease and relief from symptoms in the short term, lasting progress is achieved through an integrated approach. This approach should incorporate other forms of therapy and medication alongside supervised doses of ketamine. This multifaceted strategy can create new neural pathways to promote long-term resilience against depression symptoms.
So let's talk about oral ketamine. I'm going to give you a systematic review of that. There is a growing trend for at-home ketamine treatments. Ketamine has become an increasingly popular form of treatment for depression, and the most cost effective route of administration is oral. As the number of companies providing access to ketamine without medical supervision is growing. So are the concerns about the potential for misuse. There are potential risks about this method, such as an addiction at high doses. It's important to remember that recreational drug use must always be taken seriously. If your own usage has become a concern, then there are numerous resources available out there offering help and guidance. Healthcare providers that provide oral ketamine is addressing the issue of substance abuse by shipping a limited quantity of at any given time. These providers are providing ketamine in lozenges and troche forms, these lozenges should be held under the tug until dissolved about seven to 10 minutes without swallowing or spitting out.
And I can tell you these lozenges have been described by reviewers and clinic and patients as tasting like Drano. Not that anybody's ever had Drano, but they taste awful. Unfortunately. It's very true.
At home, ketamine offers convenience but requires extra precaution. Monitoring is vital for safety as the drug can raise blood pressure and lower oxygen rates. Making a doctor's office the most ideal setting to administer it. Most at-home providers send out a blood pressure monitor along with their treatment, so patients are able to take measurements before and after treatment.
Unfortunately, this isn't enough if the levels get too high during use. To ensure patient safety, all at-home providers require someone to be present with them while they're undergoing the therapy. They take the pill they expect someone to be there. You have to remember, these services remain unregulated and they lack sufficient training, which further complicates matters regarding the safe administration of this.
At-home providers also carry out medical screenings prior to their clients starting treatments and they worked together to provide beneficial treatments with fewer risks involved.
But I want to share an experience one of my clients had. Debbie suffered from anxiety symptoms and depression for decades. She researched ketamine treatment and thought she would try the most cost effective treatment first. She's basically a physically healthy, middle-aged female. Her only medical condition is arthritis and hypothyroidism.
She takes levothyroxin to maintain her thyroid levels and Debbie's thyroid levels have been stable for years. Debbie filled out a short medical online screening form to see if she was a candidate. After that, she had a very brief televisit with a practitioner that deemed her a candidate to start oral Ketamine.
This practitioner never discussed Debbie's health issues or medications, just her symptoms of depression and anxiety. Debbie was approved immediately. She did ask what situations would a candidate be denied treatment. She learned that the reasons for disqualification for treatment would be patients that have a high blood pressure or a history of addiction, and a person with serious mental health issues like acute suicidal thoughts.
Debbie received her Ketamine pills in the mail. She asked a friend to stay with her for a while as she took her lozenge. The taste was absolutely horrible. She tried hard not to vomit as she struggled to keep it in her mouth without swallowing for 10 minutes. She made it to the seven minute mark.
Because she is cautious and was not sure how she would respond, Debbie only took half a dose for her first dose. Her friend stayed for two hours and left. That night debbie could not sleep. She started obsessing about many things. She lost her appetite and felt very energized. Later she told me that she was feeling so overwhelmed and became unable to process anything.
She felt as if her body was on overdrive. Several days later, Debbie was still struggling with no appetite and anxiety, as well as a feeling of being in a constant hyper state. She did research into ketamine and thyroid conditions to find out that ketamine is contraindicated.
When Debbie made the at-home provider aware of her adverse reaction. They took no responsibility. Debbie not only experienced no benefit from the oral ketamine, it caused her harm. Debbie felt that the at-home provider should have warned her of the potential side effects, especially with thyroid conditions but they did not. Debbie felt that instead they put her in harm's way. So as a nurse, I understand people want to have relief from their depression. I know. I get it. I suffer from treatment resistant depression. I just don't think that at-home, ketamine treatments are safe. At least not now. There are too many things that can go wrong and you want to be able to rely on your providers to take care of you, educate you, but at this point in time, there is no regulation on this type of treatment. I personally feel that providers are doing a misservice to their customers. For those struggling with mental health issues, these developments provide access to improved quality of life that they may have previously thought unattainable. I'm not sure this route of administration is safer at home use. Which leads me, let's talk about Ketamine nasal spray called Esketamine.
Esketamine is an F D A approved version of the widely used ketamine drug. It's chemical makeup allows a lower dose to be taken, making it two to five times more potent than its parent molecule. In addition, this nasal spray form makes taking Esketamine much simpler and easier for patients. It is a cost effective treatment option for those seeking relief from treatment-resistant depression.
While Esketamine may provide a glimmer of hope to those suffering from depression, it is important to understand that there are still risks and uncertainties associated with its use. Alongside potential side effects such as dizziness, blood pressure spikes, or feeling disconnected from reality, the fact remains that more research needs to be conducted regarding long-term safety considerations.
The effects from ketamine nasal spray kick in and may not reach peak until two hours after administration. This makes ketamine nasal spray a much slower acting medication than intravenous ketamine. Of course, it is important to understand that only a small part of the dosage will actually be absorbed by the brain.
The goal for each treatment is to reach a disassociative state. That level of disassociation from intranasal ketamine may be dramatically less than that with IV Ketamine administration resulting in a less effective result. There are so many variables that come into play with intranasal ketamine. Some of the medication may run down your throat or land on mucus versus the nasal membrane. Moisture content in your nose and even your aim all play a role in getting the dose into your body.
Ketamine in this form can be an effective solution to managing symptoms. However, it's important to understand the strength of the dose. Make sure you speak with your healthcare professional about how many milligrams per spray they recommend for best results. If intranasal administration doesn't seem to work or give the desired relief, don't assume that you're non-responsive.
Simply try another form of ketamine. I want to share one of my client's experiences with the Ketamine nasal spray. Lisa suffers from a traumatic brain injury. She is also a caregiver for her father with dementia. Holidays are so challenging for her because she suffers from treatment resistant depression, as well as traumatic brain injury.
There are times when Lisa has has been admitted to the hospital to a behavioral health unit. This year, Lisa's healthcare providers thought she may benefit from a Esketamine nasal spray. Lisa did her homework. As a family caregiver, she is very limited financially. When she was doing her homework, she was worried that the nasal spray may not help her.
I explained that everyone responds differently and that she should give this protocol a try if she felt that was something she wanted to do. After all, her therapist set a comprehensive plan of talk therapy and Lisa had to continue to take her antidepressants and added intranasal ketamine into her plan.
I think that was a great plan. I spoke to Lisa after her first dose of ketamine. That single dose, Lisa felt her disassociative state. It was the week before Thanksgiving, and always a challenging time for her. The entire holiday season is painful for her. This year, after following the protocol for six weeks, Lisa not only avoided an admission to the behavioral health unit, but she was actually feeling better.
She was not experiencing the depressive symptoms. In fact, Lisa was able to look at her mental health issues and talk about them in an unemotional way. This was the detachment she needed to start to heal and overcome her depression. Now that leads me to the ketamine infusion, the gold standard of treatment resistant depression treatments.
Providing effective ketamine treatment is a fine balance of getting the right dosage into your body just as there are rules to follow for other medications, such as taking them at specific times and titrating them up or down, IV Ketamine treatments need careful consideration too. IV Ketamine treatments provide an effective way to deliver the drug directly into your bloodstream and brain, and it's circumventing the digestive process, which can reduce its potency. Studies show that 84% of oral ketamine is converted into other chemicals during digestion therefore reducing how much actually reaches its intended target making IV delivery a far more reliable option for those seeking relief from pain or depression symptoms. Ketamine may offer a promising alternative for those who have not seen results from traditional S R I antidepressant Medications and treatment. According to recent studies, the Intranasal Root, which is a combination of both Racemic ketamine, and Esketamine, as well as IV administered roots of both Racemic ketamine, and Esketamine present short-term efficacy in treating depression that are resistant to other methods. However, further research is still required before oral administrations
effectiveness can be established with certainty. As the potential of ketamine to treat mental health disorders grows, it's increasingly become accessible and cost effective option for people suffering from serious illnesses. Even though intravenous or IV infusions remain popular due to their favorable results, at-home administration through nasal spray or injection can be just as effective in providing relief or maintenance often with life-changing consequences. Therefore, having this alternative can play a critical role in improving your quality of life for many sufferers across the globe. I'm Diane Carbo with caregiver relief.
