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About 16 million Americans experience major depression each year and at any given time about one in ten adults is taking antidepressants. There are many different ones available, in what can seem like a bewildering variety.
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A relatively new possible treatment that may be considered in persons who haven’t benefitted from traditional antidepressants is ketamine. It is an off-label use for a surgical anesthetic. In this case, it has to be given in low doses with intravenous infusions lasting about 45 minutes, in a series of about six treatments over the course of about two weeks.
The remarkable aspect of ketamine treatment is that often benefits are starting as soon as the same day. A single dose has been reported to reduce suicidal thinking for up to a week and is partially independent of alterations in a person’s mood. For this reason, some researchers think that it might potentially be useful in suicidal thinking which occurs in other conditions such as PTSD.
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The duration of benefits is still under study but may be as short as a few days or as long as up to 12 weeks. Side effects can include visual difficulty and confusion. When used in surgery, about 12 percent of persons have ‘emergence reactions’ which can range from pleasant dream-like experiences to hallucinations, and it is unclear how frequently these occur when treating depression.
Whether ketamine is helpful in the long-term has not yet been determined. It is not yet a well-established treatment and may be significant more for the hope it brings for finding potentially new drugs which act on receptors for the neurotransmitter glutamate. One currently in development is esketamine which is administered as an intranasal spray.
About the Author:
Wallace B. Mendelson is a Professor of Psychiatry and Clinical Pharmacology, Distinguished Fellow of the American Psychiatric Association, and author of Understanding Antidepressants. In Understanding Antidepressants, Dr. Mendelson makes sense of the many treatments for depression and shows that understanding how antidepressants work can help in making better decisions. Written with both scientific rigor and compassion, Understanding Antidepressants is a useful guide for anyone suffering from depression, as well as their families.
