Ketamine, a substance commonly associated with recreational use and anesthesia, has shown increasing potential as a treatment for individuals suffering from treatment-resistant depression. While a recent study conducted in Australasia has demonstrated positive results with ketamine injections, there are still uncertainties regarding the long-term effects of this treatment. Additionally, there are alternative delivery methods and other treatment options available for this form of depression.
For over five decades, ketamine has been used as a potent general anesthetic. Additionally, it is known as an illicit drug that is prone to abuse and is classified as a psychedelic substance. Psychedelics have the ability to significantly alter certain neurotransmitters in the brain, resulting in profound changes in mood, perception, and anxiety levels. Early animal studies involving ketamine revealed a significant increase in the levels of specific brain chemicals, such as dopamine, by up to 400 percent. These findings led researchers to explore the effects of ketamine on the human brain.
Today, lower doses of ketamine, below the threshold used for anesthesia, are being utilized to treat individuals with treatment-resistant depression. This term refers to patients who have tried at least two different antidepressants without experiencing any improvement in their condition. However, prescribing ketamine requires strict conditions and careful observation to mitigate potential risks, such as an increased risk of suicide ideation. Therefore, individuals undergoing ketamine treatment need to be assessed and monitored not only during their therapy but also afterward.
Despite its potential benefits, some healthcare professionals have reservations about adopting ketamine as a treatment option due to its potential for abuse. Ketamine is also used to treat other mental health disorders, including post-traumatic stress disorder (PTSD). The use of ketamine as a treatment for depression requires further research and consideration before becoming a widely accepted option.
A recent study conducted across multiple centers in Australia and New Zealand aimed to compare the efficacy of ketamine injections to another drug in the treatment of treatment-resistant depression. The trial involved 184 participants who were randomly assigned to different groups, with some receiving ketamine injections and others receiving the drug midazolam, administered twice a week over four weeks. Neither the participants nor the assessors were aware of the treatment assignments.
At the beginning of the study, all participants had a clinical depression score of at least 20, indicating moderate depression. The researchers monitored the participants’ scores to identify any shifts from depression to remission, indicated by a score of less than 11. After four weeks, the results showed a significant difference between the ketamine group (19.6 percent in remission) and the midazolam group (2 percent). Another measure of improvement, halving of the depression score, also revealed a substantial difference (29 percent compared to 4 percent).
However, the sustained improvement in symptoms among the ketamine group was limited four weeks after the treatment concluded, suggesting that longer treatment periods may be necessary. This raises questions about the ideal duration and frequency of ketamine treatments for long-term efficacy.
In the trial, ketamine was administered through subcutaneous injections, a cost-effective and efficient option. However, ketamine can also be delivered intravenously through a drip. Although these delivery methods are currently limited to clinical trials in Australia and New Zealand, there is an approved nasal spray formulation of ketamine available in both countries. Ongoing research aims to understand the practical applications and compare the effectiveness of each delivery option.
Apart from ketamine, there are other drug and non-drug treatment options for individuals with treatment-resistant depression. It is important to note that depression can have severe consequences, including suicide and prolonged suffering. The latest research offers promising outcomes for individuals struggling with difficult-to-treat symptoms. However, these treatment options are not yet widely accessible outside of clinical trials, and the only approved form of ketamine treatment available in Australia and New Zealand is the nasal spray.
If you or someone you know is affected by the issues discussed in this article or if you have concerns about mental health, it is crucial to reach out for support. Lifeline at 13 11 14 provides assistance, and Beyond Blue offers a free resource called “A guide to what works for depression.” Additionally, consulting with a doctor is essential if your current treatment is not yielding the desired results, as they can provide information on alternative options and guide you towards the most suitable treatment path.
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