Ketamine Therapy Showing Promise for Treating Depression, AnxietyApr 25, 2023 11:02AM ● By Liv Osby
Millions of Americans suffer from depression. Millions more struggle with anxiety.
And while there are medications and therapies available to treat these conditions, they don’t always work.
Increasingly, health care providers are turning to a decades-old anesthesia drug to help – ketamine.
Originally developed in the 1960s, ketamine was approved by the FDA in 1970 and used during the Vietnam War before more widespread medical use.
By the early 2000s, researchers at Yale University discovered that it could help relieve symptoms of depression – and the effect occurred within hours rather than the four to six weeks that traditional antidepressants typically take to work.
The treatment can be a medical breakthrough for many patients, says Dr. Jennifer Jones, a psychiatrist and assistant professor in the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina.
“It’s not a cure-all,” she said. “But it can really be a game-changer for many people.”
And Dr. Jay Motley, a Greenville anesthesiologist who’s been offering ketamine therapy since last year, agrees.
“Patients have typically suffered from a mental health condition for years and have taken many different medications, and some have even considered electroconvulsive therapy, or ECT,” he said.
“The results (of ketamine) can be pretty remarkable.”
After treatment, he says, patients are asked to score their level of depression or anxiety, and they often show dramatic improvement, some to a level where they’re not considered depressed anymore.
But it doesn’t work for everyone. Research shows that about 75 percent of patients who’d tried other medications for depression without relief get better with ketamine, he adds.
It’s unknown why some people don’t respond to ketamine, the doctors say.
“There is still a lot of work going on to see how it works best and who it works best on,” Jones said. “But roughly speaking, three out of four people who have tried it will have some level of response to ketamine, and some will have a significant response.”
Nationwide, more than 8 percent of adults, or about 21 million people, had at least one major depressive episode in 2020, according to the National Alliance on Mental Illness.
Meanwhile, anxiety disorders affect nearly 20 percent of adults, or more than 40 million people, and about 9 million, or 3.6 percent of adults, are affected by PTSD – 37 percent of them with severe symptoms, NAMI reports.
Typically administered either intravenously or through a nasal spray, ketamine works by targeting a certain brain receptor, increasing the levels of glutamate and enabling the formation of new pathways in the brain that change old thought patterns allowing patients to view the world differently, Motley said.
“It increases neuroplasticity and helps people to break old habits, or actions or thoughts, and make new ones,” Jones said. “It can be a really powerful catalyst for change.”
Motley said he’s been using ketamine regularly as an anesthetic in the OR for 16 years but became interested in its use for mental health conditions about five years ago when he began to see research showing its promise in treating depression.
At his practice, MindWell, patients are ushered to a tranquil, darkened setting and administered an IV while peaceful music is played. The session lasts about an hour, he said.
While the experience is different for everybody, patients generally emerge feeling calm and refreshed, he said.
“Most patients find it hard to describe,” he said. “They feel like they have a sense of connectedness, a sense of love or peace. It’s kind of a dream state, but they’re aware all the time.
“It’s an impactful experience,” he added, “but nothing like they expected.”
Patients’ sense of time is distorted as well, Jones said, adding they report feeling more resilient after treatment.
“They may feel more of an ability to not sweat the small stuff,” she said, “to be present in the moment, and be able to connect more readily with other people, to sit with difficult emotions more easily.”
One Upstate patient who struggled with lifelong major depression that was resistant to traditional medications said the treatment has made a remarkable difference.
“When I say it’s been life-changing, that’s not overstated. After the very first treatment, I felt better. It was like a light switch was turned on,” the patient said.
“I feel happy. But more than happy, peaceful. My life is great, and that’s all that matters. I can tell you that in years and years, I’ve never had this many weeks in my life that my mind has been at peace and I just felt like I’m embracing life. I’m so excited for what is to come.”
Motley said his patients are referred by psychiatrists or other doctors who have diagnosed them with depression or anxiety.
The IV treatments are typically provided as six infusions over two weeks with maintenance visits scheduled as needed, sometimes monthly or up to every three months with some patients eventually needing no more treatments, he said.
While some say they feel better after the first treatment, most say they are better after three or four sessions, Motley said.
Side effects are temporary and can include nausea, vomiting, sleepiness, and elevated blood pressure, he said.
Jones says the “overwhelming majority” of patients at her clinic have worked with a psychiatrist or primary care doctor, and have tried other treatments without the kind of results they’d hoped for. And while it doesn’t serve as a general diagnostic center, the clinic does its own consultations to make sure the patient does indeed have depression or anxiety, she said.
“If people are considering … ketamine, they need to make sure they’re working with someone objectively checking in to see if symptoms are improving with treatment,” she said. “It’s important to work with someone who has training in mental health disorders.”
For some people, ketamine is an alternative treatment and for others it’s an adjunct to turbocharge existing therapy, Jones said. And sometimes it’s used in combination with psychotherapy.
“It doesn’t have to be all or nothing,” she said.
Jones also says treatment should be provided under medical supervision and monitoring so there is support for any potential side effects, like increased blood pressure, which can be serious for people with vascular conditions. Ketamine also might not be appropriate for people with schizophrenia, she said.
“It’s safe, but not completely benign,” she said. “It should be done under rigorous monitoring and at least under medical supervision.”
Jones says there’s no indication from the research that medically supervised ketamine treatments make symptoms worse in the long term.
“Typically, people do well with it,” she said.
Dr. Eman Sharawy, a psychiatrist with the South Carolina Department of Mental Health’s Beckman Center for Mental Health Services in Greenwood, says there are four years of data showing that the ketamine nasal spray, called Spravato, is safe and effective.
“The benefits outweigh the risks,” she said. “There are no serious safety concerns.”
Beckman is currently the state’s only mental health center using ketamine therapy, she said. It only uses Spravato and only for major depressive disorder in adults who haven’t responded to two or more medications, as well as those with suicidal thoughts, she said.
But the treatment has been beneficial for many people, she said, and she expects it will be expanded to other mental health centers around the state eventually.
In one study, Sharawy said, 90 percent of patients got 50 percent better after two treatments and after six treatments, there was an 85 percent reduction in symptoms.
“After people have exhausted other treatments, this a very good option,” she said. “It’s very promising.”
Patients must be selected carefully because the drug has the potential to be addictive, she said. And patients also must have an appropriate diagnosis and will need continued follow-up care to monitor the sustainability of improvement, she said.
The treatment is administered at the center in a quiet, relaxing room and the patient is closely monitored for two hours, Sharawy said, noting that Spravato is also used at 18 private centers across the state.
Costs for treatment vary widely by facility, Jones said, noting that some treatments, most often Spravato, are covered by insurance.
At the Beckman center, patients with major depressive disorder often have some level of coverage for the treatment, and there are also patient assistance programs for uninsured patients, Sharawy said.
The doctors say that while ketamine isn’t a miracle drug, it can be part of the solution to treating these conditions.
And Sharawy said it shows promising results in a short period of time.
“It’s not for everybody, and every patient is different,” she said. “But it gives patients hope and … better quality of life.”
Jones said that research has shown that for many people, ketamine can work on depression a lot more quickly and help with the severely depressed who have thoughts of suicide.
“This is not a panacea for every person for every condition,” she said.
“But it’s a great new tool and can be critical for people … that have suffered for a long time with a serious condition and not been able to achieve success with day-to-day meds. They can get better.”
If you or someone you know is experiencing a mental health crisis, call the National Suicide and Crisis Lifeline at 988.