Ketamine: Demystifying Mental Health’s Latest Frontier

By  //  August 12, 2021

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Ketamine, the dissociative anesthetic strictly regulated in most countries, is finally enjoying mainstream recognition as a treatment for depression. Mental health professionals and patients alike are hailing ketamine as a breakthrough treatment. However, some find it difficult to shake the stigma of illegality that follows “special K,” long known as an easy-to-abuse club drug and Schedule II controlled substance.

With the number of legitimate ketamine clinics in the United States only growing, and enthusiasm for the treatment growing in turn, it’s important to demystify ketamine and understand its worth as a treatment for depression.

Discovered in 1956 and successfully synthesized in 1962 by a professor at Wayne State University, ketamine was originally intended for use as a pediatric anesthetic, but has since become a popular option for general anesthesia in all ages, and even in veterinary settings. Ketamine is also used as a pain relief drug, sometimes preferable to opioids due to exhibiting fewer adverse side effects such as respiratory depression.

Its psychoactive properties were noticeable immediately during early clinical trials. The dissociative mental state noted in the first human test subjects was dubbed “dreaming” by researchers, but due to resistance from pharmaceutical backer Parke-Davis — now a subsidiary of pharma giant Pfizer Inc. — the state of ketamine intoxication would be officially labeled “dissociative anesthesia” to describe the sense of disconnectedness experienced by patients. The rejected wording foreshadowed the positive psychological effects of the drug.

After years of legitimate use in medicine and illicit recreational use, the efficacy of ketamine as an antidepressant medication was confirmed in 2000. In 2014, former director of the National Institute for Mental Health Thomas Insel suggested ketamine “might be the most important breakthrough in antidepressant treatment in decades.” The NIMH itself continues to promote the efficacy of ketamine as an antidepressant.

Unlike conventional antidepressants, like the SSRIs commonly prescribed to depressed patients, ketamine is fast acting. Whereas SSRIs only become effective after continued use, ketamine has a comparably immediate effect on neurotransmitter activity, improving the microstructures of neurons right away. SSRIs, by contrast, must build up in the patient’s system before effects are noticed.

In the two decades since its recognition as a solution to treatment-resistant depression, the administration of ketamine for that purpose in a clinical setting has been refined and perfected, leading to overwhelmingly positive results.

Ketamine clinics have now been established throughout the United States, with the drug legally available to mental health professionals who obtain the appropriate DEA authorization to possess and administer the drug. Currently, the number of American ketamine clinics in operation numbers over one hundred.

Ketamine is administered either intravenously or nasally by way of sprayable esketamine solution. While nasal sprays demonstrate ease of use and are preferred by many patients, intravenous injection under the care and direct supervision of a professional is considered by most to be the ideal method of administration.

A typical intravenous ketamine program, such as the much-lauded program offered by TMS & Brain Health, begins with a thorough patient assessment and evaluation to determine if ketamine will be a necessary and effective medication for the patient’s condition. This will determine the exact structure of the treatment to ensure the best possible results and maximum amount of comfort.

Those undergoing intravenous infusion of ketamine are given a sub-anesthetic, body weight-dependent dose. This can be accompanied by sensory deprivation measures, such as ear and eye coverings to diminish audiovisual distractions that may diminish the dreamlike state induced by the drug.

The treatment is usually received while laying down or reclining. During infusion sessions, patients are never left unaccompanied; a technician is always present to answer questions, ease concerns, and ensure a generally positive and anxiety-free experience.

Ketamine infusions are performed in six infusions over the course of two or three weeks, and it is not uncommon for patients to return for standalone sessions if it is deemed necessary by both the patient and clinic. Most patients report noticeable relief only an hour after their first session, and, generally, patients are enthusiastic about the results of their treatment.

Ketamine’s entrance into the mainstream has been, so far, graceful — good news for those suffering from treatment-resistant depression.

With the United States beginning to ease restrictions on various historically prohibited substances in order to support research into their medicinal and therapeutic applications — psilocybin-containing magic mushrooms are another promising contender for depression treatment — we’ll likely see ketamine’s popularity as a mental health treatment grow.