How Does Ketamine Drug Help With Depression?

The Food and Drug Administration (FDA) approved the first drug for major depression in decades, ketamine migraine treatment, an anesthetic that has made its name from its surprising antidepressant effect. As ketamine assists patients with treatment-resistant depression, which means that the treatment did not help them, the FDA hurried the process to approve it to make it available quickly. In a study, 70 percent of patients with treatment-resistant depression started on an oral antidepressant. Intranasal ketamine improved compared to just over half in the group that did not receive the medication (called the placebo group). Ketamine has been acting as a game-changer.  

The drug works differently than others, acting as "the anti-medication" compounded progesterone. Most medications like valium have anti-anxiety effects on you only when it is in your system. When the effect of the drug goes away, you may get rebound anxiety. Ketamine triggers reactions in your cortex that enables brain connections to regrow. The presence of ketamine nasal spray for migraines in the body and its reaction to ketamine constitutes its effects. And this is precisely what makes ketamine a unique antidepressant. 

Ketamine For Severe Depression: New Treatment, New Questions

However, the availability of ketamine through prescription gives birth to several questions such as: How does it work? Is it safe? Who should get it? For answers, please read further.  

What is ketamine?

It was used to be used as an anesthetic on the battlegrounds and in the operating rooms. Now, this drug is gaining popularity as a promising treatment for major depression, which is the leading cause of disability worldwide. Recent studies indicate that 16 million adults have an episode of major depression in a year in the US. Suicide rates increased substantially between 1999 and 2016, increasing by more than 30% in twenty-five states. Because of its rapid effect, Oxytocin Nasal Spray could play a role in helping the prevention of suicide.

How do antidepressants work?

It's not completely clear how ketamine works. As it exerts an antidepressant effect through a new mechanism, ketamine may be able to help people manage depression successfully when other treatments have not worked.

Research for ketamine as an antidepressant started in the 1990s at the Yale School of Medicine. At that time, depression was considered a "black box" disease which means that very little was known about its source and itself. A popular theory was the serotonin hypothesis, which claimed that people with depression had low serotonin levels. This hypothesis came into existence by accident—certain drugs given to treat other diseases like high blood pressure and tuberculosis seemed to affect people's moods significantly. Those that decreased serotonin levels caused symptoms like depression; others that increased serotonin levels created euphoric feelings in patients dealing with depression. This discovery escorted to a new class of drugs meant to treat depression, known as selective serotonin reuptake inhibitors (SSRIs). The first in the market was Prozac.  

Antidepressants Working

But eventually, it became evident that this hypothesis didn't fully explain depression. The SSRIs are limited to helping more than one-third of people with depression. Growing research demonstrated that the neurotransmitters serotonin target accounts for less than 20 percent of the neurotransmitters in the brain. The remaining 80 percent are neurotransmitters. Known as GABA and glutamate. Which play a role in seizure disorders and schizophrenia. Together, these two neurotransmitters form a complex push-and-pull response. Sparking and stopping activity in the brain. Researchers believe these may be responsible for regulating most brain activity, including mood.  

Specifically, severe stress can change the glutamate signaling in the brain and affect the neurons. Making them less adjustable and less able to communicate with other neurons. Stress and depression themselves make it harder to deal with adverse events. A cycle that can make situations even worse for people struggling with complex life activities.  

Ketamine also may affect depression in several other ways. For example, it might reduce signals contributing to inflammation. Associated with mood disorders or facilitate communication within specific areas in the brain. Most likely, ketamine works in several ways simultaneously, many of which are being studied.

Ketamine— a "miracle drug" 

Interestingly, studies showed that ketamine triggers glutamate production, which, in a complex and cascading series of events, prompts the brain to form new brain connections. This makes the brain more adaptable and creates new pathways, and allows patients to develop positive thoughts and behaviors. These effects had not been seen before, even with traditional antidepressants.  

For the last two decades, the researchers at Yale have led the research by experimenting with using subanesthetic doses of ketamine delivered intravenously under observation for patients struggling with severe depression and whose conditions have not improved with standard antidepressant treatments. The results of this experiment showed a significant decrease in depression symptoms in just 24 hours in patients who felt no improvement in using other antidepressant medications.      

Also, ketamine is only part of the treatment for a person with depression. It has been most effective when taken in combination with an oral antidepressant. For these reasons, ketamine cannot be considered a first-line treatment option for depression. It's only prescribed in moderate to severe major depressive disorder cases, which at least two other depression medications haven't helped.  

It has possibly shown to be effective when taken in blend with an oral upper. Therefore, ketamine isn't viewed as a first-line treatment choice for despondency. It's just recommended for individuals with moderate to serious significant burdensome issues, which without a doubt, two other sad drugs haven't made a difference. The FDA approval of ketamine gives doctors another valuable tool in their arsenal against depression—and offers new hope for patients no one had been able to help before.

Why is ketamine exciting for treating depression?

Other medications for treating depression and suicidal thoughts usually take from weeks to months, and some people might need to try several medications or approaches to relieve pain. The most effective treatments for major depression, such as talk therapies, antidepressant medicines, transcranial magnetic stimulation (TMS), and electroconvulsive therapy (ECT), fail to respond to other therapies.

On the other hand, if a person's body responds to ketamine, it can rapidly reduce suicidal thoughts and relieve other severe symptoms of depression. Ketamine is also an effective medication for treating depression combined with anxiety.

Are there different types of ketamine?

Yes, two main types of ketamine are used to treat major depression:

• Racemic ketamine

It is usually given intravenously into the bloodstream. It is also known as IV ketamine. It is a combination of two mirror-image molecules: "R" and "S" ketamine. Although it was approved by the FDA years ago as an anesthetic, it is lately being used off-label to treat depression.

• Esketamine 

Esketamine (Spravato) was FDA approved recently and is given as a nasal spray. It uses only the "S" molecule of ketamine. Till now, most research has been done on ketamine infusions.

The above-mentioned forms of ketamine interact differently with receptors in the brain. The delivery of ketamine and the given type affect the drug's effectiveness and side effects. It is unknown yet which type is more effective or how many side effects both may have. More research is needed to compare the effectiveness and side effects of both forms.

What are the possible side effects of ketamine?

We know that all drugs have side effects. But when someone is severely depressed or suicidal, the possible risks may seem very insignificant compared to the possible benefits. Possible side effects of both forms of ketamine are mentioned below:

IV Ketamine

Racemic ketamine may cause:

• high blood pressure

• perceptual disturbances (for example, time appearing to speed up or slow down; colors, textures, and noises that seem incredibly stimulating; blurry vision)

• nausea and vomiting

• Dissociation; although rare, a person may feel as if they are looking down on their body.

Generally, any changes in dissociation or perception are most noticeable during the first infusion and end right afterward. 

Ketamine Intranasal 

Esketamine nasal spray may cause similar side effects. However, the timing and severity of those effects are different. Frequent or long-term use of ketamine may have more side effects. Further research on this is needed.

What else should you know about ketamine?

• A very low dose naltrexone side effects of ketamine are given for depression than the dose necessary for anesthesia.

• Like opioids, ketamine has addictive properties. It's essential to have an understanding of this when the pros and cons. If you have a history of drug abuse or drinking, you must consult with your doctor thoroughly to consider whether ketamine is a good option.

• When IV ketamine works, people usually respond to it within one to three infusions. Someone shows no improvement, further infusions are probably not going to help. Rather, it's probably best to try other treatments for oxytocin for depression.

• People who get some relief from depression within a few ketamine treatments are very likely to use ketamine several more times to extend these positive effects. The subsequent treatment sessions may help prolong the effects of ketamine instead of achieving further surprising relief of symptoms. There are no typical guidelines for this. Many studies suggest eight treatments initially (acute phase). After this, the patient and doctor decide whatever needs to happen.