3 posts tagged “mood disorders”

Can ketamine help when antidepressants don’t? A closer look at the off-label drug that’s in the spotlight

Posted May 21st, 2018 by

You may have seen ketamine making headlines recently as a promising drug therapy for treatment-resistant depression, or “TRD.” (What’s TRD? Health care professionals define it as receiving at least two different antidepressants– for at least six weeks in a row, and at an adequate dosage – but experiencing less than a 50% improvement in depressive symptoms.)

So, how does it work and what does the research show so far? Get the facts below — plus find some helpful insight on side effects and more from PatientsLikeMe members who have tried ketamine.

Let’s back up — what is ketamine?

Ketamine has been around since the 1960s, and over the years it has been used as an anesthetic, treatment for some types of pain and a sedative in certain instances. It’s also been abused as a “party drug” due to its hallucinogenic high. But in the 2000s, researchers discovered that ketamine could also have rapid antidepressant effects — in as little as 24 hours — for those with TRD when administered in a small, single dose IV infusion.

A number of clinical trials have since linked the effects of ketamine with improvement in symptoms of major depressive disorder (MDD), as researchers continue to find the optimal dose and the best administration routes (like potentially a nasal spray). Ketamine continues to be studied further in other mood disorders like PTSD and OCD with a focus on its long-term safety.

How does ketamine work?

Researchers are still figuring out the specifics, but the drug seems to affect receptors in the brain, including two called NMDA and AMPA:

  • Ketamine stimulates the AMPA receptor, which increases levels of the protein BDNF (brain-derived neurotrophic factor). This protein helps form new neurons and synapses in the brain, which is thought to improve certain mood conditions such as MDD.
  • Ketamine also blocks the NMDA receptor, which in turn causes an increase in glutamate levels (glutamate is an important neurotransmitter in the brain) and results in a cascade of positive neurobiological changes.
  • Both of these pathways and possibly others that still aren’t fully understood are related to the way ketamine works as an antidepressant.

The research looks promising…

There are currently several ongoing clinical trials involving ketamine and MDD and PTSD — and here’s a breakdown of what other recent research has found:

  • One Cochrane review looked at 25 randomized controlled trials involving ketamine’s effects on brain receptors in people with severe depression. It found that while other antidepressants can take 6 to 8 weeks to become effective, ketamine may offer rapid effects in comparison to a placebo. The authors noted that the initial studies are small and there’s uncertainty about how long ketamine’s effects last.
  • Another 2016 study of 14 patients with TRD found that after 3 weeks of twice-weekly ketamine infusions, 7 (50%) experienced remission from suicidal thoughts. Two of these 7 people maintained remission for 3 months.
  • There isn’t quite as much data about the use of ketamine to treat PTSD, but one trial that has been published showed a significant reduction in PTSD symptoms.

The patient perspective: Real-world reviews of ketamine

  • “I am currently receiving IV racemic ketamine once every 2-2.5 weeks at a 0.5mg/kg dose,” says one PatientsLikeMe member. “I haven’t been successful at spacing treatments further out than once every three weeks and 2-2.5 weeks seems to be the sweet spot for me, and I don’t have significant crashes.”
  • Another member says, “Ketamine has saved my life. After failing so many medication trials and ECT, I thought I had run out of options. I am so lucky to be able to access this treatment.”
  • “I am currently receiving IV ketamine 0.5mg/kg every other week in an outpatient setting,” says one member. “I am feeling very well, probably better than I ever have in my life. Ketamine has been a game changer for me.”

Ketamine’s long-term effectiveness

Despite positive findings on ketamine’s rapid effectiveness, researchers are unsure if the antidepressant effects are sustained beyond two weeks and what the consequences of relapse are. Take one PatientsLikeMe member’s experience:

“I received ketamine as part of a clinical trial. Within 24 hours I felt like ‘myself’ again and was able to experience pleasure and internalize positive experiences. The effects lasted about 9 days and then all my previous symptoms returned.”

Side effects, cost, and other things to consider

Ketamine is currently only FDA-approved for surgical anesthesia, so it must be prescribed off-label (not for its intended use). And because it’s off label, it must be administered by a specialty clinic, which means it may not be covered by insurance and can come with a hefty price tag at $400-$800 per infusion. Learn more about available clinical trials here (and be sure to talk to your doctor before changing anything about your treatment regimen).

And what about side effects? In short, more data and research is needed. But here’s what other members who have tried ketamine for MDD have said:

  • “The worst side effect is nausea, but I receive ondansetron before the infusion and that helps significantly. I have only had one ‘bad trip’ or ‘K-hole’ while getting the infusion, but it quickly subsided.”
  • “I have found that during an infusion, external stimuli intensifies and I can get quickly overwhelmed. To avoid this, I always wear headphones and have music that is very familiar to me playing, and I typically have my eyes closed for much of the time. This also mitigates most of the perceptual disturbances that might occur during an infusion. I am a person who does not like feeling out of control, so I limit my exposure to external stimuli and that helps significantly.”

Have you tried ketamine or been involved in a ketamine clinical study? Join or sign in to PatientsLikeMe to jump in the conversation today.

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Getting out of bed: The “One hour rule” and other tips

Posted March 12th, 2018 by

Does getting out of bed in the morning ever seem like an overwhelming task? You’re not alone. PatientsLikeMe members are talking about it a lot in the mental health forum. Read on to learn what’s worked for others on difficult mornings.

Give yourself no more than an hour

Elyse Raffery, contributor to The Mighty, shared her strategy for the “One Hour Rule” to get out of bed on the days she’d rather not move from beneath the covers:

“Within one hour of waking up, I have to be out of my bed. If I look at the clock when I wake up and it is 9 a.m., by 10 a.m., I cannot still be lying in bed. I am a competitive person, and even some gentle competition with my own brain helps me sometimes.”

Louder alarms, brighter lights and more tips from PatientsLikeMe members

Check out these practical morning tips from other members in the forum:

“I got a much louder alarm. I went back to the classic two bell analog alarm clock… so loud that my cat bolts from the room.”

“Now I have a routine where I get up, turn the light on, and listen to the radio for ten minutes. Then I get out of bed. The ‘light’ is a full-spectrum, really bright light. You might find that turning on bright lights when you get up helps. You can put them on timers, too, so that they light up when your alarm goes off.”

“Write down or think about something you are looking forward to on the next morning/day. Motivate yourself to want to get up by planning a special item for breakfast (cinnamon toast) or wearing a certain shirt you like or planning a half hour of your favorite music with headphones for the first ten minutes. Something that will keep your head on straight.”

Some shared wisdom from around the web:

  • Make small goals: “If you can’t do one thing a day, try one thing every two days, or even one thing every week. A slowly fought battle is still one you can win in the end.”
  • Ask for help: “We’re all human, there are times we can all benefit from support.”
  • If you have a pet: “Pets are also something great to turn to, as they rely on you to care for them, which gives you a sense of responsibility each day.”

Try to get enough sleep the night before

Chronic sleep problems — common in many mental health conditions — can often be part of the issue. According to the Harvard Health Newsletter,

  • Sleep problems affect more than 65% to 90% of adult patients with major depression
  • In bipolar depression, 23% to 78% of patients report that they have trouble getting out of bed
  • Sleep problems are also common in people with post-traumatic stress disorder (PTSD).

Here are some strategies for sleeping better (and potentially getting up more easily.) Talk to your doctor about what might work best for you:

  • Exercise can improve sleep, and can help regulate your mood to make mornings easier
  • Maintaining a regular sleep-and-wake schedule, or “sleep training” — staying awake longer so that your sleep is more restful
  • Keeping your bedroom cool and dark, and banishing electronics from the bedroom
  • Meditation and guided imagery, deep breathing, and progressive muscle relaxation ─ alternately tensing and relaxing muscles ─ can reduce anxiety that can ruin sleep and make mornings so hard

Have you tried the “One Hour Rule” or something else to help you get out of bed? Log in or join PatientsLikeMe and jump in the conversation.

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