Jeff Winograd has not known adult life without depression. From the age of 20, he tried ketamine therapy practically every antidepressant on the market. But he says, “The depression was just constant.”
By the time he was 45, a father of two young children and a struggling film and video producer in Portland, OR at the time, Winograd had hit rock bottom. The depression was so strong that he felt paralyzed.
“I sat on the couch all day, I couldn’t move, I couldn’t move my legs,” he says. “And I was suicidal. I would sit and try to figure out how I was going to do it without hurting my kids.”
It was around this time that a doctor friend told him about ketamine therapy for treating resistant depression.
What is Ketamine Therapy?
Ketamine therapy began in Belgium in the 1960s as an anesthetic for animals. It was approved by the FDA as a human anesthetic in 1970. It was used to treat wounded soldiers on the battlefields of the Vietnam War.
Paramedics can give it to a distraught patient who, for example, has been saved from a suicide attempt. Ken Stewart, MD, says doctors are beginning to realize that the drug has powerful effects against depression and suicidal thoughts.
“Someone tries to jump off a bridge and they give him ketamine in the ambulance to sedate him, and 9 months later he says, ‘I haven’t felt suicidal in 9 months.’
“When these stories started piling up, doctors said, ‘Maybe there’s something here,'” says Stewart, an emergency room physician and founder of Insight Ketamine in Santa Fe, NM. Like the drug itself, Stewart got his start in combat medicine during the Vietnam War. Some doctors also use ketamine therapy to treat suicidal thoughts.
Ketamine therapy causes what doctors call a “dissociative experience” and what most others would call a “trip.” So it became a club drug, called K, Special K, Super K and Vitamin K, among others. Partiers inject it, put it in drinks, snort it or add it to joints or cigarettes.
What Is Included In Ketamine Therapy?
“Ketamine therapy can induce feelings of unreality; visual and sensory distortion; distorted sense of one’s own body; temporary unusual thoughts and beliefs; and euphoria or buzzing,” says John Krystal, MD, chief of psychiatry at Yale-New Haven Hospital and Yale School of Medicine in Connecticut, where he is a leader in the study of ketamine’s antidepressant effects.
The trip takes about 2 hours. However, there are risks of normal use. The most serious are unconsciousness, high blood pressure and dangerously slowed breathing. The drug could also cause long-term problems such as ulcers and pain in the bladder; kidney problems; abdominal pain; Depression; and bad memory. Ketamine can be fatal for people who abuse alcohol or if you drink it while drunk.
But the drug’s potential as a treatment for depression and an antidote to suicidal thoughts has drawn the attention of researchers. They have studied and administered it in controlled clinical settings to help with treatment-resistant depression and other conditions.
To be clear: Occasional use is not a treatment for depression. But doctors have developed a protocol for use under medical supervision that can help people who don’t get relief from other drugs.
“We’re reaching patients who have not responded to other types of treatment in a new way, giving some of them the first time they’ve recovered from depression,” says Krystal.
Ketamine Intake
Ketamine comes in several forms. The only FDA-approved treatment for depression is a nasal spray called esketamine (Spravato). It is for adults who have either not been helped by anti-depressant pills, have major depressive disorder or are suicidal. They continue their antidepressant medication and receive esketamine in a doctor’s office or clinic where they are monitored by a health care provider for 2 hours after the dose.
For treatment-resistant depression, patients usually receive a nasal spray twice a week for 1 to 4 weeks; then once a week for weeks 5 to 9; and then once a week or 2 after that.
The spray has a “black box” warning about the risk of sedation and problems with attention, judgment and thinking, as well as the risk of misuse or abuse of the drug and suicidal thoughts and behavior.
Other forms of ketamine not approved by the FDA for mental illness include IV infusion, injection into the arm, or lozenges. Most research looks at ketamine given IV. You can only get it by IV or shot at a doctor’s office. Some doctors prescribe lozenges for home use – often to maintain depression between infusions.
At his clinic, Stewart only sees patients who have a referral from a doctor who has diagnosed them with treatment-resistant depression. Stewart does not make these diagnoses. It starts patients with six research-based infusions over 3 weeks.
Research
“That’s how people get started,” Krystal says. “Two infusions a week, and then it goes down to one infusion a week, and then most people eventually go to one infusion every 2 to 4 weeks.”
Most research stops initial treatment after 6 weeks. There is no research to suggest that more than 6 weeks in a row provides more benefits, although people do return for boosters if symptoms return.
An IV infusion takes about 40 minutes. The dissociative experience starts quickly and takes about 15 to 20 minutes to wear off after the drip is finished. A doctor is always present during the entire process. The doctor is not necessarily in the room with the person being treated, but is available if they need anything or are nervous or confused.
While the patient is on the drip, Stewart says they appear to be asleep. Most do not move or speak. Although some, he says, may speak or comment on the music playing in their headphones, or some part of their experience, or perhaps ask where they are. If they don’t need something, Stewart says, no one interferes.
Christa Coulter-Scott, a pediatric nurse from Athens, GA, received treatment in a similar setting in Gainesville, GA. She says she didn’t want to wake up. “It was like a spiritual journey. I felt warm, safe and confident. As the treatment continued, all the weight of stress gradually fell off me. I felt like I had the power of the universe at my fingertips.”
PTSD
It’s a bold statement from a 51-year-old man who has felt helpless against depression and anxiety since childhood. She was also diagnose with PTSD and chronic pain as an adult. Coulter-Scott has tried 10 different antidepressants over the years. But the dark cloud of depression never lifted.
Still, after ketamine therapy, she says, “My head feels lighter and I don’t have that gloomy, dark, heavy feeling in my mind. And everything around me looks brighter – the sun, the lights in my office.”
When she return to work the next day after the infusion, she ask a co-worker if the lighting had been change. it wasn’t “I don’t know if it’s a side effect of the ketamine therapy or a side effect of minor depression.”
Winograd describes it similarly. He talks about feeling like he’s floating in paint. “It was the first time I understood the term ‘happy place.’ It was this space where everything related to my real life disappeared and I had no weight that I carry with me everywhere I go. ”
Ketamine’s antidepressant effects wear off within hours, days, or weeks in people who receive just one infusion. A series of infusions has longer-term effects.
Back to real life
At Stewart’s clinic, after the mind-altering part of the ketamine experience is over, a medical professional sits and talks with the patient in a process called integration. Other clinics may refer patients to continue talk therapy elsewhere.
“I feel like it’s important,” Stewart says. “When people come out of this really deep experience, they have a lot to say, and these are people who have a lot of baggage and a lot of experiential pain. Ketamine often leads to unpacking that baggage.”
Krystal, which provides IV and intranasal ketamine therapy for treatment-resistant mood disorders at the VA Connecticut Health System and Yale-New Haven Hospital, encourages patients to continue psychotherapy after ketamine treatment.
Doctors who administer IV ketamine therapy tend to recommend that patients also continue a regular antidepressant regimen. As for the nasal spray, it is only approve for use with an oral antidepressant.
“Ketamine is an intervention, but the term ‘treatment’ is much broader,” he says.
Weeks, months, or years after the first series of six to eight doses, patients may return for revaccination. There is no standard recommendation for when or if people need a booster. They discuss it with their doctor if symptoms of depression start to reappear.
“For about 30% of people who finish the whole series, it is. They’re never coming back,” says Stewart. “For those who come back for boosters, the boosters seem to get further and further apart until eventually they don’t need them again.”
How does it work
For both Winograd and Coulter-Scott, and the estimated 70% of people who try ketamine under medical supervision for a mental health condition, the benefits of ketamine continue after the trip is over. Scientists are investigating why this might be.
Here’s what they know so far: A few people with depression don’t get the drug trip that ketamine therapy usually causes, but still report relief from depression that starts a few days after a dose.
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