Ketamine for Depression
Ketamine was approved for use in anesthesia during the early 1970’s and quickly became one of the most commonly used drugs for the induction of anesthesia. It is listed on the “World Health Organization’s List of Essential Medicines” primarily because, unlike other anesthetics, it provides general anesthesia without interfering with a person’s ability to breath. Ketamine is frequently used in emergency rooms as a sedative and anesthetic for adults and children undergoing painful procedures.
The first study looking at ketamine for depression was published in 2000 by a group at Yale University. It was another six years before another study was published by Dr. Zarate at NIH. He followed this with a second study with similar positive results published in 2010. Two years later Time magazine published a story entitled “Ketamine for Depression: The Most Important Advance in Field in 50 Years?” which was the first mainstream recognition of Ketamine’s alternative use in the treatment of depression.
The initial excitement surrounding Ketamine’s alternative use was based on a couple unique attributes. The treatment works through a different mechanism than most antidepressants. While roughly 55% of patients do not respond to standard antidepressant medications[1], Ketamine has been shown to benefit 70% of those difficult to treat patients[2]. In addition, Ketamine produces results more quickly than conventional medicines. Rather than waiting weeks to realize effectiveness, most Ketamine patients notice relief within a few days. While it has even been shown to eliminate suicidal thoughts in some patients within 24 hours most patients do not notice appreciable benefits until about 24 hours after their second infusion.
1. Khan A, Mar KF, Faucett J et al. World Psychiatry 2017;16:181‐92.
2. Diazgranados N, Ibrahim L, Zarate C, et. al. Arch Gen Psychiatry. 2010 Aug; 67(8): 793–802.
Ketamine for Pain
Ketamine has been shown to be beneficial in providing clinically significant relief of nerve pain. Certainly, during the infusion there is pain relief but there is minimal data on the duration of pain relief. Several studies have shown that there is a correlation between the length of treatment and the length of pain relief. However, there is no consensus as to the best treatment plan. Some centers insist on patients getting ten 4-hour infusions over a two week period. However, due to the cost and time commitment, we recommend starting with 4-hour infusions on four consecutive days and determine the need for further infusions based on the patient’s response.
