What is Ketamine?
Ketamine is a substance that was first synthesized in Wayne State University in the early 1960s. It was being used as a medicine to induce anesthesia. Gradually it was discovered that at lower doses it had pain relieving attributes as well. It has recently been discovered to help with depression as well. Ketamine has also been studied for a number of mental health problems including Substance Dependencies, Depression, PTSD, Bipolar Depression and Chronic Pain. Noticing this effect, Esketamine (a form of Ketamine) was studied and then approved by FDA (Food and Drug Administration) for use in Treatment Resistant Depression. This has resulted in the efficacious use of this medicine to treat depression that has been resistant to various other traditional antidepressants.
The Molecule, Ketamine
Ketamine works in a way unlike any of the traditional antidepressants. Instead of working on Serotonin, Dopamine or Norepinephrine, it works on the NMDA and AMPA receptor. The molecule that caused the antidepressant effect of Ketamine was discovered at the University of Texas. NMDA receptor is a glutamate and ion-channel protein receptor that gets activated when glutamate and glycine bind to it. Another receptor called the AMPA also gets activated with Ketamine and is responsible for the antidepressant effect. Ketamine at low doses also interacts with the opiate receptor, hence its use in chronic pain.
Safety studies with Ketamine
Ketamine’s high safety index was recognized early. It earned a name as the “buddy drug” in the Vietnam war. It was given to soldiers to administer to each other in case of injuries till they were transported to more intensive medical services. That fact however does not mean that Ketamine is free of side effects. Like any other medicines, it also has a list of side effects. That is why it is necessary for health care professionals to monitor its use.
Ketamine has significantly more side effects when it is used at anesthetic doses. For mental health however Ketamine is used in sub-anesthetic doses. At these doses it can produce psychedelic effects which, without adequate preparation, can be scary.
Ketamine can be used orally, sublingually, intravenously or intramuscularly. All of these routes of administration have their pros and cons, and different types of administration are suitable for different scenarios.
Ketamine is being used as a mental health treatment by Anesthesiologists, Emergency room physicians and Psychiatrists. Anesthesiologists and Emergency Room physicians also use it for anesthesia and pain control during various procedures.
The Ketamine Clinic: Pros and Cons
The Ketamine infusion clinic is becoming increasingly popular nowadays. Most of these clinics offer intravenous Ketamine, and most clinics are not run by psychiatrists. Some psychiatrists refer people to these clinics to receive a number of Ketamine treatments. The physicians or health care personnel running these clinics administer a prescribed number of Ketamine infusions in a controlled setting and then discharge the patient to the referring psychiatrist. Some Ketamine clinics also provide ongoing support through Ketamine and relational care.
The treatment usually involves being hooked up to an IV for an hour while watching and hearing calming media. It is a medical setting that involves taking blood pressures and frequent check-ins with medical personnel. The dose is usually escalated based on tolerance with each treatment. Sometimes, but not often, a psychedelic effect is also reached in the latter. However, that is not the aim of the treatment. Typically, 6 treatments are recommended over a period of 3 weeks with each treatment running at around $500-$600. For some people a maintenance model of 1-2 treatments per week is recommended.
Our practice believes that, although popular, Ketamine infusions treatment delivered in the absence of therapy is not preferable.