In the past few years, Ketamine use for depression has exploded in popularity. Ketamine clinics have popped up throughout the United States. As more and more research is conducted, a few things have become clear. First, Ketamine is a useful medication for the acute treatment of severe depression and/or suicidal thoughts. However, Ketamine is not a permanent cure for these issues. The effects of Ketamine on depressive and suicidal symptoms can begin immediately after the first infusion, or after several infusions. Although there is not specific research delineating the duration of Ketamine’s effect on ameliorating depressive and suicidal symptoms, in general the effects last while the infusions are taking place and up to several weeks afterwards.
PCH Treatment Center offers Ketamine infusions on site. Clients who will undergo Ketamine administration need to understand that it is not a curative, but rather adjunctive treatment to help them maximize their potential in the PCH treatment progams. It is important that Ketamine is used in conjunction with psychotherapy and medication management. At PCH, we have specific indications for Ketamine treatment. We perform a thorough assessment, and a multidisciplinary team then meets to evaluate the appropriateness of Ketamine therapy for any specific client. Indications include severe depressive symptoms that are interfering with a client’s ability to attend or engage in programming and/or suicidal thoughts or behaviors. Ketamine is also useful to stabilize a client with severe depression or suicidality while their medication regimen is optimized and they are integrating into therapies and therapeutic relationships.
Ketamine is a potent anesthetic agent and is pharmacologically related to phencyclidine (PCP), a well-known hallucinogenic. Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist. It has been used for anesthesia in the United States for over 50 years both for humans and in veterinary medicine. At subanesthetic doses (doses that do not alter consciousness), Ketamine has been shown to increase brain glutamate levels. This mechanism is important because glutamate pathways are altered in patients with major depressive disorder. There is also abnormal glutamate–glutamine–gamma-aminobutyric acid functioning in persons who are suicidal. No other antidepressant medications work to modulate the glutamatergic system – this makes Ketamine a unique pharmacologic tool.
Ketamine has been observed to rapidly reduce depressive symptoms and suicidal ideation (SI). A recent study in the Journal Depression and Anxiety concluded that “A single infusion of ketamine can be a safe and feasible treatment option for depressed, suicidal patients. We found it to alleviate suicidal ideation in the first hours after infusion.” Ketamine has a specific impact on SI that is independent of improvement in depression and anxiety. Current treatment options for suicidality are limited. They include brain stimulation (such as Electroconvulsive Therapy or Transcranial Magnetic Stimulation) and pharmacological interventions. Medications that have been shown to effectively treat suicidality have a slow onset and long duration of action. The efficacy of lithium in treating suicidality has been documented. Clozapine has also been shown to reduce suicide risk in patients with schizophrenia. Both lithium and clozapine require a significant time to efficacy and are thus not useful in an urgent or emergent psychiatric state. The studies performed so far show promising trends of Ketamine being an effective and rapid treatment with minimal side effects for suicidality.
In summary, PCH Treatment finds that Ketamine is useful for specific clients in our programs who are experiencing severe depression and/or suicidal ideation. PCH will perform Ketamine infusions on site as a part of our integrated treatment programs, to help clients better participate in their programming and to feel safer. Ketamine infusions are administered on the PCH premises by PCH Co-Founder Terry Krekorian, M.D., who is a Board-Certified Anesthesiologist. Dr. Krekorian has administered hundreds of Ketamine infusions and full safety protocols and monitoring are employed.