Are Repeated Ketamine Treatments Safe For Depression?
According to the World Health Organization, depression has now surpassed HIV, AIDS, malaria, diabetes, and war as the leading cause of disability. It is estimated that 16.2 million Americans have experienced a major depressive episode, and depression is much more common in females than males. Some studies report up to 20% of teenagers experiencing depression before they reach adulthood, and statistics are showing that it’s actually increasing.
Furthermore, with the current COVD-19 pandemic, civil unrest, and heightened stress levels worldwide, our psychological health is challenged even more. Experts are anticipating significant impacts in the rates of anxiety and depression.
The current standard treatment for depression is oral antidepressants that affect the monoamine levels within the synapses (i.e. serotonin) in the brain. Unfortunately, these medications can take weeks to months for an effect and up to one-half do not experience remission of symptoms even after trying multiple medications.
Recent clinical research has shown that off-label use of ketamine (which works on the N-methyl-D-aspartate receptors and glutamatergic system) can be rapidly beneficial for some patients suffering from depression. Typically, they will need to get boosters to maintain their improvements after the initial series of treatments.
Are Repeated Ketamine Treatments Safe For Depression?
Because ketamine has a history of illicit use (“club drug”) and use in the veterinary community (“horse tranquilizer”) there’s a lot of misconceptions about ketamine and it’s side effects. Also the bulk of research looking at the adverse effects (bladder, liver, kidney dysfunction, and memory issues) are mainly derived from those who chronically abuse ketamine.
But what are the adverse effects in those receiving ketamine with a physician in a controlled, monitored environment for depression?
A research article published in Pharmaceuticals, July 2020 addresses this question. Dr. Feifel et al. surveyed a group of physicians who use therapeutic ketamine for their patients.
SURVEY RESULTS
The survey included 27 physicians, who had collectively treated 6,630 patients for depression. About one-third of these patients had been under treatment for longer than 1 year, and another third had received more than 10 individual ketamine treatments.
They found that less than 1% of patients experienced an adverse effect that required them to stop ketamine treatments. The most frequent cause of discontinuation was psychological distress.
See full data from Dr. Feifel et al. here.
LIMITATIONS
Some limitations of this research are that those surveyed may be affected by recall bias and not remember the exact details of all patients. Also, physicians were not asked about the varying doses or treatment protocols. Accordingly, the results may not be generalizable to other ketamine clinics. Lastly, the main author has a reported conflict of interest in that he owns a practice that provides ketamine treatment for depression.
AT OUR CLINIC
Some of the more common side effects that we have seen at Reset Ketamine clinic are: hypertension, nausea, anxiety, and hypoxia. Fortunately, these can be treated with intravenous medications, supplemental oxygen, and supportive care in the clinic.
Of note, we have seen one of each: seizure and irregular cardiac rhythm (paroxysmal atrial fibrillation) which lead to discontinuation of further ketamine treatments.
CONCLUSION
Depression is challenging for our society worldwide with the potential to get worse due to recent societal stressors. The current standard treatment of oral antidepressants can work for some people, but may take a long time to take effect and come with significant side effects.
Off-label use of ketamine can help, but can require repeated maintenance treatments. Fortunately, the survey results looking at the “real-world clinical” application of therapeutic ketamine show a very low rate of adverse effects requiring discontinuation of ketamine treatments. Although adverse effects are rare, they can happen.
Accordingly, when you receive ketamine treatments, you want to be confident that you are in a safe, monitored, healing environment with professionals who have extensive experience with ketamine administration.