Where ketamine is legal, like the U.S., it’s usually used for medical reasons. In other countries, it’s a controlled substance. Ketamine has been getting a lot of media attention because of its potential to treat depression—especially treatment-resistant depression—and help people with suicidal thoughts.
Using ketamine for depression is promising in many ways. But there are also some downsides to the treatment.
What Is Ketamine?
Ketamine is a dissociative drug. This means it distorts your perceptions and makes you feel detached from your environment and your sense of self. In low doses, it can create a stimulating or drunk feeling, which is why it’s commonly used as a club drug. At higher doses, ketamine can produce:
- Out-of-body experiences
- Mystical states
The drug affects the NMDA receptors in your brain. Like other NMDA receptor antagonists, it’s a dissociative anesthetic. This means it causes many of the same effects of anesthesia but doesn’t typically make you lose consciousness.
Other dissociative anesthetics are:
- Nitrous oxide (laughing gas)
- Dextromethorphan (DXM)
- Phencyclidine (PCP)
Ketamine, sold as Ketalar® in the U.S., is used as a sedative and as pain management in emergency rooms and emergency surgery in war zones. It’s not usually the go-to anesthetic because it can produce hallucinations.
In the U.S., when ketamine isn’t being used in medical situations, it’s a Schedule III drug. According to the Drug Enforcement Administration (DEA), this means it has less potential for abuse than Schedule I and II drugs, but “abuse may lead to moderate or low physical dependence or high psychological dependence.”
The Downsides of Ketamine for Depression
It’s not clear what the best dosage of ketamine is for antidepressant effects. Many ketamine clinics use sub-anesthetic doses. That means they won’t cause anesthesia, but they can still produce hallucinations, which many patients don’t want. If you try ketamine to treat depression, be prepared for these intense effects.
Most clinical studies on ketamine for depression last only two weeks, so it’s not clear how long relief lasts.
Ketamine can cost $400 to $1,000 per infusion. Clinics also charge around $350 for a consultation. During your initial treatment, a clinic will provide one or two infusions a week for three weeks. Regular, follow-up infusions every few weeks and clinic fees can increase prices.
Ketamine is not an FDA-approved depression treatment, so it is unlikely to be covered by insurance.
Unpleasant Side Effects
There are potential risks and unpleasant effects associated with ketamine:
- Damage to the bladder
- Liver damage
- Impaired motor function
- Respiratory problems
- Kidney issues
- Stomach pain
The way ketamine is used in clinics may avoid dependency, but more research needs to be done to assess the best dosage of the drug and the effects of long-term therapy.
Ketamine for Depression
Depression and suicide are serious, growing, global issues. Depression is the leading cause of disability worldwide. It’s also the most common mental health disorder that underlies suicide attempts. Around one-third of patients with major depressive disorder have failed to find a treatment which offers them relief.
How It Works
Ketamine can produce antidepressant effects very quickly, but it’s not clear exactly how it relieves depression. Researchers have a number of theories. The work of two professors of psychiatry at Yale shows that ketamine triggers the release of glutamate. This is a neurotransmitter that can encourage synapses (connections) in your brain to grow.
Depression has been linked to a loss of—or damage to—synaptic connections in brain regions associated with the condition. These regions include the limbic system, the emotional center of the brain. Clinical studies show a single dose of ketamine treatment can reverse this damage.
Using ketamine for depression works differently than traditional antidepressant medications. SSRIs, for example, treat depression by changing the levels of the neurotransmitter serotonin in the brain. These changes help regulate mood and reduce the symptoms of depression.
Ketamine, on the other hand, releases glutamate, which helps alter the structure of the brain itself. Ketamine treatment may address the structural cause of depression in a way other antidepressants don’t. The use of ketamine for depression also avoids the unwanted side effects that many antidepressants have, like:
- Agitation or anxiety
- Indigestion or stomach aches
- Diarrhea or constipation
- Loss of appetite
- Low sex drive
- Erectile dysfunction
- Suicidal thoughts
There are still issues, side effects, and risks linked to ketamine that depressed patients should be aware of.
Esketamine for Depression
The FDA has approved a new treatment that claims to alleviate depression in a matter of hours. It’s known as esketamine and sold under the brand name Spravato™. It is a chemical cousin of ketamine.
Doctors may now prescribe Spravato to patients who suffer from treatment-resistant depression. Esketamine is meant to offer relief to patients who have found no help from other drugs. It may also be effective at lifting severe symptoms of depression, such as suicidal ideation.
Like ketamine, esketamine can produce hallucinations and out-of-body experiences in high doses. This may be less likely with Spravato, as the drug is administered in low doses.
Success Rates of Ketamine
The use of ketamine for depression is fairly recent. It has been used as an anesthetic for longer. Ketamine is not an FDA-approved treatment for depression, but several studies show its promise. A small study in 2006 showed that ketamine had rapid antidepressant effects. These results were verified in later clinical studies.
Researchers have found that a single, sub-anesthetic dose of ketamine injected into the veins could produce antidepressant and anti-suicidal effects in 4.5 hours for people with treatment-resistant depression.
These effects were still there after 24 hours after ketamine was administered. Over 40% of participants felt its benefits after 7 days.
Depressed patients with suicidal thoughts need fast-acting and effective treatment to protect them from self-harm and potentially fatal acts. A clinical study published in The American Journal of Psychiatry found that ketamine quickly and significantly reduced suicidal thoughts in depressed patients. These effects lasted up to six weeks.
When it can take several weeks to feel relief on antidepressant medications, the speedy response to ketamine sounds hopeful.
While ketamine hasn’t been approved or marketed as an antidepressant, many ‘ketamine clinics’ have opened across the U.S. At these clinics, patients with depression receive a series of ketamine infusions—often 10 infusions over 10 weeks.
Mental health professionals also provide talk therapy before and after the intravenous infusions. Having a mental health professional there helps protect the well-being of patients and ensure better outcomes.
Ketamine to treat depression has burst onto the scene in a big way, and it does show some promise. But the small amount of research may indicate that more time is needed for studies on how it works on the brain and its long-term effects.
If you’re looking for depression treatment that’s drug-free and FDA-approved, learn more about transcranial magnetic stimulation. Success TMS offers compassionate, experienced treatment at more than 30 locations across the U.S.