2 posts tagged “antidepressant treatment evaluations”

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.

ketamine formula on blackboard

 

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.


Mental Illness Awareness Week 2012: Dismantling the Stigma

Posted October 11th, 2012 by

Did you know that one in four adults – or approximately 57.7 million Americans – experiences a mental health problem in any given year?  Or that one in 17 lives with a serious, chronic mental illness?

It's Mental Illness Awareness Week

Since 1990, National Mental Illness Awareness Week has been recognized by the U.S. Congress as a time for mental health advocates and patients to join together for various awareness-raising activities. Sponsored by National Alliance on Mental Illness (NAMI), the goal of this week is to transform the way we think about mental illness, which is defined by NAMI as “a medical condition that disrupts a person’s thinking, feeling, mood, ability to relate to others and daily functioning.”

Important Phone Numbers to Have on Hand in the Event of Mental Health Crisis

Like any other medical condition affecting a particular organ, mental illness is not caused by personal weakness or character defects, and it can affect individuals of any age, race, religion or income.  As an example, some famous people who are known to have lived with mental illness include Abraham Lincoln, Winston Churchill, Gandhi, Tennessee Williams and Mike Wallace (who was eulogized by one of our members last June).  Below is a new PSA ad for National Mental Illness Awareness Week 2012 that focuses on some of these legendary icons, stressing that “you are not alone in this fight.”

But what about feeling like no one understands what you’re going through?  That’s where finding others like you – such as those with the same diagnosis (or diagnoses), symptoms or treatment side effects – comes in.  At PatientsLikeMe, we have tens of thousands of patients sharing their experiences with more than 60 mental health conditions, including:

In addition to exchanging in-depth treatment evaluations about the effectiveness and side effects of commonly prescribed medications such as Cymbalta, Klonopin or Wellbutrin, our members are connecting and supporting each other daily in our Mental Health and Behavior Forum.  Currently, there are more than 39,000 participants and more than 333,000 posts in this highly active forum, where you can find answers, empathy, humor and thought-provoking conversations day or night.

Get to know our mental health community – including what depression feels like to them or how PatientsLikeMe has helped them be more open about their condition – today.  Also, stay tuned for some tips from our community about what to do and not do when interacting with someone who is living with a mental health condition.