click here to see all of x’s ketamine journey blog posts

 

 

This blog is not intended to promote the recreational use of ketamine, but to inform readers about its use as a treatment for refractory depression.

 

 

Depression affects over seventeen million people in the U.S. However, it is important to distinguish between acute, situational depression and the chronic, major depression that is genetically predetermined and often triggered by a traumatic experience or experiences during childhood or adolescence. Situational depression affects adults and is a direct result of an emotionally taxing experience, such as a break up, divorce, loss of a job, or death of a loved one. Situational depression can be addressed by short-term use of antidepressant medications and/or psychotherapy, after which the brain will eventually self-correct and treatment is no longer necessary. However, chronic, major depression is a disease that cannot and will not self-correct.

Refractory depression is chronic, major depression that does not respond to any of the various classes of antidepressant medication. The most effective, documented treatment for refractory depression is electroconvulsive therapy, or ECT. Offshoots of traditional ECT, like transcranial magnetic stimulation (TCM), vagus nerve stimulation (VNS) and deep brain stimulation (DBS), have also proved effective in the treatment of refractory depression with a lessening of the severe short-term memory loss associated with ECT. However, these treatments are extremely expensive and, as such, are not viable options for many people who suffer from refractory depression.

Researchers first realized the therapeutic effects of ketamine on depression about twelve years ago. Like many psychotropic discoveries, the realization that ketamine had therapeutic effects on depression was anecdotal to the primary research, which then led to clinical trials specific to the effects of ketamine on depression. Further research revealed that ketamine blocks the N-methyl-D-aspartic acid (NMDA) receptors, which are the brain’s glutamate receptors, an area that had previously not been recognized as relevant to depression, the focus instead being on serotonin, dopamine, and norepinephrine receptors.

Several pharmaceutical companies have developed a new class of antidepressant that targets the NMDA receptors of the brain and are currently conducting clinical trials on these drugs, including AZD6765 by AstraZeneca and GLYX-13 by Naurex. However, it will be many years before the trials are concluded, the drugs are approved by the FDA, and they actually reach the market.

In the meantime, those whose lives are crippled by refractory depression continue to suffer. It is important to note that ketamine itself is a treatment option for those with refractory depression. Unfortunately, it is an option very few psychiatrists are even aware of (which is problematic in and of itself since ketamine is a buzzword for anyone who keeps up with current research on mental illness.)

Ketamine is a dissociative anesthetic most commonly used by veterinarians, pediatric anesthesiologists and in field surgery in combat zones. It is a derivative of phencyclidine (PCP) and is a schedule III controlled substance in the U.S. In adults it can cause hallucinations and a dissociative state. As a result of its hallucinogenic and dissociative properties, it is a popular club drug dubbed Special K. The dose taken for the treatment of refractory depression (.5 milligrams per kilogram of body weight) is significantly lower than the anesthetic dose ( 2-4.5 mg/kg) and the dose taken recreationally (1-2 mg/kg). Mild dissociative and hallucinogenic effects may be felt at the antidepressant dose. Due to the lack of research into the long-term effects of regular ketamine use, this is not a drug to be prescribed or taken lightly. However, for me, it has been the miracle I never believed I would experience. The following blogs will enable you to follow my ketamine experience and understand the importance of this drug for those with refractory depression.

 

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