Ketamine might be better known as a recreational drug or anesthetic. But there is growing evidence of its use for people with hard-to-treat depression.
An Australian study released today showed some positive results for people with treatment-resistant depression when given ketamine injections.
But we don’t know if these effects are sustained long-term, and there are other ways to deliver ketamine. There are other treatment options for this type of depression as well.
Read more: Weekly dose: Ketamine, an anesthetic and recreational drug, could be used to treat depression
What is Ketamine?
Ketamine has been used as a powerful general anesthetic for more than 50 years.
It is also an illicit drug of abuse and is considered a psychedelic substance. Psychedelics drastically alter certain neurotransmitters (chemical messengers) in the brain to create a profound change in perception, mood and anxiety.
In early animal studies, ketamine led to increased levels of certain brain chemicals, such as dopamine, by up to 400%. This led researchers to try ketamine in humans to see what would happen to our brains.
Now, doses of ketamine (at less than what is used as an anesthetic) are being used to help treatment-resistant depression. This is when someone has tried at least two antidepressants and shows no improvement.
It is usually prescribed under strict observation and conditions that mitigate some serious risks, such as increasing feelings of suicide in some people. So people need to be evaluated and monitored not only during treatment, but afterward as well.
But some doctors have resisted using ketamine because of its potential to become a drug of abuse.
Ketamine is also used to treat other mental health disorders such as PTSD (post-traumatic stress disorder).
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How about this new study?
The research involved several centers in Australia and New Zealand and compared the effectiveness of ketamine injected under the skin versus taking another drug in treating people with treatment-resistant depression.
The study randomized 184 study participants into several groups, some receiving ketamine, the rest the drug midazolam, twice a week for four weeks. Neither the study participants nor those evaluating the results knew who was on ketamine and who was not.
At the start of the study, all participants had a clinical depression score of at least 20 (moderate depression) using a particular scale known as the Montgomery-Asberg Depression Rating Scale.
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The researchers then looked for a score below 11, indicating a transition from a depression to remission.
After four weeks, there was a large difference between people receiving ketamine (19.6% in remission) versus midazolam (2%). Another less stringent way to measure outcomes is to look for a depression score halving. This had an even bigger difference (29% versus 4%).
However, only limited sustained improvement in symptoms occurred in the ketamine group four weeks after the end of treatment. This suggests that treatment may be needed for a longer period.
Read more: Do psychedelics really work to treat depression and PTSD? Here’s what the evidence says
There are other options
In the study, ketamine was administered via a subcutaneous injection, which is a cheap and efficient option. But ketamine can also be delivered directly into the bloodstream via an intravenous drip. Neither of these options is normally available in Australia and New Zealand outside of clinical trials.
A third option uses a different form of ketamine and is available in a nasal spray (approved for use in Australia and New Zealand).
Each option provides ketamine in different amounts, and research is ongoing into how they work in practice and how they compare.
There are other drug and nondrug options for treatment-resistant depression as well. These include:
In short words
The serious consequences of depression include suicide or a life of anguish. This latest research shows promise for people whose symptoms are more difficult to treat. But this option is not yet widely available outside of a clinical trial. Only the ketamine nasal spray has been approved for use in Australia and New Zealand.
There are other treatments as well. So, if existing treatment isn’t working for you, talk to your doctor who will explain what else is available.
If this article raised any concerns for you, or if you are concerned about someone you know, please call Lifeline on 13 11 14. Beyond Blue provides the free resource A Guide to What Works for Depression.
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