Data supporting the potential of intravenous ketamine to revolutionize the treatment of major depression keeps streaming in.
Researchers from Yale and the National Institute of Mental Health have studied 30 patients with depression and tracked their brainwave activity after receiving ketamine infusions. The medication actually caused a burst of new connections to form in areas of the brain linked to mood and emotion.
A medication that can actually cause nerve cells to form more working synapses—the fluid filled spaces across which chemical messengers flow—represents an entirely new and potentially revolutionary weapon in psychiatry’s arsenal.
This is why Science magazine has reflected that ketamine may represent the most important development in psychopharmacology in several decades.
The Yale/NIMH data comes on the heels of a study from the Ben Taub General Hospital in Houston, Texas, showing that a large percentage of patients who receive ketamine infusions report nearly instantaneous relief from its most debilitating symptoms.
Ketamine, or Special K as it is known on the streets, when used illicitly, can cause feelings of unreality and hallucinations. Its side effects—even when given in a medical environment—can include psychotic experiences, bladder problems and heart problems. Serious side effects are very rare. That’s why dentists use ketamine as anesthesia for many of their procedures; it’s much safer than many other agents.
Clearly, diluted solutions of ketamine, administered over about 45 minutes by IV, appear to be well-tolerated by patients and to rapidly yield increased mood, hopefulness and self-esteem. The infusions can also reduce anxiety and chronic pain. I am very hopeful that it will turn out to have benefits in elderly patients whose mood and memory have waned.
Ketamine is turning out to provide windows of hope into the future for people who have struggled and seen only darkness for months or years. Some of these patients have not benefited from psychiatric medications or even from electroconvulsive therapy (ECT). Some of these patients were contemplating suicide and were relieved almost instantly of the desire to end their lives. They feel hopeful again. They feel motivated again. And the relief from a single dose of ketamine can last for weeks. This opens up the possibility that those who were hostage to nearly unbearable suffering could have the weight lifted from their shoulders by seeing a doctor for a weekly dose, or even a dose every two weeks.
It is possible that experiencing a period of well-being for a week might be enough, in and of itself, to give patients hope and keep them moving toward recovery.
I have been impressed enough about ketamine to call on the FDA to fast-track its approval as an antidepressant. And I have recently also begun—in partnership with an internal medicine physician—administering ketamine to patients with depression who have not responded well to one or more antidepressants. The results have been extremely good—sometimes, astounding.
Insight oriented psychotherapy must always be part of the formula for a full and lasting recovery from depression and anxiety. But ketamine—with its ability to actually increase brain connectivity—may, indeed, be another part of that formula.
Keith Ablow, MD is a psychiatrist, and was host of the nationally-syndicated "Dr. Keith Ablow Show." He is a former member of the Fox News Medical A Team.