Ketamine's Path to Healing Treatment-Resistant Mental Illness

OIG4

What is Ketamine Treatment?

Ketamine was first developed as an anesthetic agent and was later found to have a rapid and strong antidepressant effect.

Numerous studies have demonstrated that a single dose of ketamine provides an antidepressant effect within a few hours and it can be sustained up to a week.

Ketamine therapy demonstrates efficacy in managing various psychiatric conditions, encompassing major depressive disorder, bipolar depression, obsessive-compulsive disorder, anxiety disorders, and post-traumatic stress disorder.

Stimulates nervous system growth

Releases brain chemicals

Enhances neuron communication

How does Ketamine treatment improve mental disorders?

Ketamine exerts a rapid therapeutic effect by performing several actions in the brain.

  • Unlike regular antidepressants which takes a few weeks to be effective, ketamine acts quickly often within days. It does this by temporarily changing how a specific type of receptor in the brain, called NMDA receptors, works. These receptors are like switches that control communication between brain cells.

  • Ketamine boosts glutamatergic transmission – Glutamate is a chemical that helps brain cells communicate better. When glutamate functions more effectively, it assists the brain in changing and adapting. This means it can form new connections between brain cells, which are important for improving mood.
  • Ketamine improves the brain plasticity. When ketamine stimulates these receptors, it triggers a series of reactions in the brain, including making new proteins in the brain, such as brain-derived neurotrophic factor (BDNF), which are needed for improving the changeability of the brain (i.e. brain plasticity).
human brain 2021 08 26 15 33 00 utc 1
  • Unlike regular antidepressants which takes a few weeks to be effective, ketamine acts quickly often within days. It does this by temporarily changing how a specific type of receptor in the brain, called NMDA receptors, works. These receptors are like switches that control communication between brain cells.

neurons electrical pulses 2021 08 26 18 26 30 utc 1
  • Ketamine boosts glutamatergic transmission – Glutamate is a chemical that helps brain cells communicate better. When glutamate functions more effectively, it assists the brain in changing and adapting. This means it can form new connections between brain cells, which are important for improving mood.
3d illustration model of serotonin molecule horm 2021 08 31 13 46 21 utc 
  • Ketamine improves the brain plasticity. When ketamine stimulates these receptors, it triggers a series of reactions in the brain, including making new proteins in the brain, such as brain-derived neurotrophic factor (BDNF), which are needed for improving the changeability of the brain (i.e. brain plasticity).

Conditions We Treat

  • Major depressive disorder
  • Bipolar depression
  • Post-traumatic stress disorder
  • Anxiety disorders
  • Obsessive compulsive disorder

Frequently Asked Questions

How effective is ketamine treatment?

About two-thirds of patients with treatment-resistant depression and chronic PTSD would respond to ketamine treatment, which is a reduction in half of the symptoms.

It’s imperative to emphasize that while ketamine boasts a rapid effect, the influence of a single-dose treatment is fleeting. To unlock an amplified and prolonged impact, multiple treatments are essential.

How soon can I expect to see results with ketamine treatment?

Using a twice-weekly dosing schedule, some patients would respond within a week. However, the effect tends to be short-lasting with fewer treatments. A 4-week treatment program is recommended.

What factors affect the treatment outcome?

Although ketamine treatment is effective in many patients with medication-resistant depression, there are numerous factors affecting the chance of recovery.

Positive predictors of ketamine treatment outcome include:

  • A shorter duration of depression
  • Taking a concomitant antidepressant
  • Being less treatment-resistant

Negative outcome predictors include:

  • A higher number of treatment failures
  • More severe depressive illness
How is ketamine adminstered?

While ketamine can be administered in multiple routes, our centre uses intramuscular and subcutaneous injections, as they have demonstrated effectiveness. During the induction phase, ketamine is administered twice weekly over 4 weeks.

Is maintenance treatment necessary?

A maintenance treatment plan spanning six months is recommended. Nevertheless, given that many patients undergoing ketamine treatment have shown resistance to medications, experiencing mild relapse upon discontinuation of treatment is not uncommon. In such instances, resuming ketamine treatment often proves effective in alleviating symptoms.

Who cannot receive ketamine treatment?

Ketamine administration is contraindicated in patients with a heightened cardiovascular risk, including those with unstable angina and poorly controlled hypertension. Individuals with elevated intracranial and intraocular pressure should also refrain from ketamine treatment. Furthermore, patients with uncontrolled hyperthyroidism, severe liver disease, or a history of psychosis are advised to avoid ketamine therapy.

Additionally, due to potential interactions with other substances, the use of substances and alcohol is discouraged during ketamine treatment. Pregnant patients are cautioned against undergoing ketamine therapy due to uncertainties regarding fetal risks.

Is ketamine treatment safe?

Ketamine is highly accepted by most patients. In most studies, 95-100% of patients can complete the whole treatment course.

However, like all medical treatments, ketamine can be associated with some side effects. Here is a brief overview to help you navigate your experience:

Neurological Side Effects
The most frequently reported neurological side effects of ketamine include headaches and dizziness. While less common, some individuals may also experience sedation, faintness, poor coordination, or tremors. It’s essential to note that these effects are typically short-term and tend to resolve on their own.

Psychotomimetic Side Effects
Psychotomimetic side effects refer to changes in perception or thought patterns. Dissociation, perceptual disturbances, and feelings of unreality are among the commonly reported effects. It’s reassuring to know that no long-term psychotomimetic effects have been reported in studies.

Acute Psychiatric Side Effects
During treatment, you may encounter acute psychiatric side effects such as anxiety, agitation, or mood elevation. Less frequently reported effects include detachment, emotional blunting, or psychosis. Rest assured, our team is equipped to address any concerns and provide support throughout your journey.

Cognitive Side Effects
Ketamine therapy may also impact cognitive function, leading to issues like memory loss, poor concentration, or confusion. These effects are typically short-lived and resolve with time.

We also remain vigilant regarding less common risks like long-term cognitive impairments, urinary tract symptoms and the development of tolerance.

At our clinic, we prioritize your comfort and well-being at every step of your ketamine therapy journey.

What is a ketamine bad trip?

Embark on your psychedelic journey with confidence and enlightenment. Within this transformative experience, encountering a “bad trip” entails confronting intense emotions, anxiety, and a perceived loss of control. While these experiences can be uncomfortable and challenging, it is important to remember that they are temporary and often indicative of deep-seated emotional or psychological issues that are surfacing.

Another aspect of a bad trip is the sense of time distortion. Minutes may feel like hours, and the passage of time can become disorienting. This distortion can intensify the emotional impact of the experience. However, it’s important to remember that time is subjective during a psychedelic journey, and the intensity will gradually subside as the effects wear off. Remind yourself that it’s part of the journey, and with patience and self-compassion, you can navigate through the challenging moments.

A bad trip is one in which the person experiences sensory overload, vivid hallucinations, and deep thoughts that are challenging to deal with in the moment. It is a powerful trip that takes the person out of reality and into a negative space.

In our nurturing environment, your well-being is our top priority. We provide unwavering support and guidance throughout your journey, ensuring you feel empowered and safe every step of the way.

Is ketamine treatment FDA-approved?

At present, the FDA has approved only one type of ketamine called esketamine for treating major depressive disorder. It’s a specific part of ketamine called the S-enantiomer. However, research indicates that esketamine might not work as well as the full mixture of ketamine. That is why many ketamine clinics use ketamine “off-label” for treating psychiatric disorders, even though it’s not officially approved for those uses.

How should I choose among ketamine and TMS treatments?

Both treatments demonstrate efficacy in addressing several mental illnesses, albeit through distinct mechanisms. To summarize, their efficacy is similar. Ketamine offers a rapid onset of action, whereas TMS is associated with a lower incidence of side effects.

TMS vs Ketamine
 TMSKetamine
Onset of action4-6 weeksWithin 2 weeks, sometimes within hours or days
EffectivenessSimilar, about 2/3 of patients would significantly improve and half of them would have minimal remaining symptoms.
Durability of effectMore durableLess durable
Recovery timeCan return to work straight after TMSRequires recovery time
(could be up to a few hours)Driving or operating heavy machines is not recommended on the treatment day.
Side effectsMinimal. Most common is mild headache which tends to subside with more treatments. Rarely, seizure occurs in <1/10000 treatments.More short-term side effects. About one in 5 patients suffers from nausea, and one in 3 has increased heart rate and blood pressure. Rare side effects (<1%) include hallucination, panic attacks, and confusion.
Sessions required for inductionUsually 20-30 sessions
(4-6 weeks)
About 4-6 sessions
(2-3 weeks)

Crucially, individuals who do not respond to one treatment may find success with the other. Ultimately, the decision to choose between ketamine and TMS treatment is made collaboratively, involving both the patient and healthcare provider.