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    Ketamine For Depression: Dosage, Risks And Side Effects

    Ketamine is a medication used for starting and maintaining anaesthesia. The trance-like state induced by the chemical provides pain relief as well as sedation and memory loss. The brand name of the dissociative anaesthetic is Ketalar. The chemical blocks an individual's sensory perception and causes distortion of sounds, sights, colours, self, and one's environment. Basically, the chemical takes you on a trip where you will no longer be worried about the pain or discomforts [1] .

    depression ketamine

    Once the chemical enters your body through the means of an injection, the effects begin within five minutes and can last for 20 to 25 minutes. The class II scheduled drug is legally approved to be used in medical settings, for animals and human beings. Ketamine does not lower your breathing rate or blood pressure levels[2] .

    The tranquillising, hallucinogenic and dissociative properties of the chemical has resulted in its being used as a recreational drug. Ketamine [3]  is one of the commonly abused recreational drugs.

    Ketamine For Depression

    Today's society is gagged by the epidemic of depression. More than 300 million people in the world are battling depression every day [4] . The overwhelming sadness, lack of interest and low energy are the characteristics of an average individual these days, pointing out the prevalence of the silent killer, depression. A larger percentage of the population believe that depression can be cured by letting it be. But, if left untreated, the condition can cause serious health complications [5] [6] .

    Various treatments and therapy methods have been introduced for battling depression [7] . Psychological, clinical and number of natural depression treatments are in practice now, indicating the increasing number of individuals suffering from the condition. Recently, a lot of studies have been conducted on exploring the impact ketamine has in treating depression. The powerful anaesthetic drug has acquired the attention of the doctors and scientists, paving way for a change in the way we treat depression [8] .

    Known by the name party drug, ketamine [9]  has been making headlines in the medical world - and that too for a good cause! Professionals in the mental health field are focused on exploring the positive impact the drug can have on individuals suffering from depression. The drug's potential to manage and control the treatment-resistant depression poses various limitations due to the nature of the drug as a 'party drug'.

    Ketamine treatment trials for individuals suffering from severe depression has been found to cause a significant reduction in the symptoms, and not just that, reports have revealed that it can provide relief for days. Ketamine is used in the case of individuals suffering from severe depression, who have not responded to other forms of therapy or treatment methods [10]  [11] .

    Ketamine's use as an antidepressant is growing rapidly, with researches expanding to explore further into the applicability of the drug for treating the symptoms of depression[12] . In a 2014 article by BBC, they wrote about the ketamine treatment, "Some patients who have faced incurable depression for decades have had symptoms disappear within hours of taking low doses of the drug".

    The rising demand for ketamine treatment is due to the remarkable positive impact it has on managing the symptoms, within 1 to 2 hours of the treatment[13] . The fewer number of side effects posed by the anaesthetic is also contributing towards its rising demand. 

    How does it work? 

    On its application, ketamine manages the symptoms of depression by regaining the balance between the receptors and the neurotransmitters (the NMDA/glutamate receptors and GABA receptors). Whereas the normal depression therapies work by blocking the re-absorption of serotonin, which is not immediately effective or effective in some cases [14] . With the ketamine blocking the glutamate receptors in the brain, it provides relief for the majority of the patients dealing with treatment-resistant depression. Treatment resistant depression is a subset of depression that does not respond to normal depression related treatments and drug interventions[15] .

    The fast relief provided by the anaesthetic drug is extremely beneficial for individuals suffering from suicidal tendencies. About 30% of people who suffer from depression do not respond to the normal depression treatments and take around seven to eight weeks to be effective, which does not provide any help in the case of individuals who has suicidal tendencies [16] . Ketamine works different in comparison to the other depression treatments, that is, it does not target the same brain activities. Ketamine has a different type of mechanism in comparison to any other medication, that is, it works on the symptoms of depression as the drug leaves your body [17]  [18] .

    Alice Levitt, a journalist of health and medicine, has been in therapy for more than 30 years - since the age of 5! Being on depression medication for more than 30 years, which did not stop the suicidal thoughts from recurring, she decided to undergo the ketamine treatment. The success rate of 70 to 85% ketamine treatments points out the triumph it has over the normal depression therapies and medications. Levitt stated, "I tried ketamine to treat my depression. Within a day, I felt relief". The real life experience of a person battling suicidal thoughts on a daily basis with the ketamine treatment is a solid example of the effect it has[19] .

    ketamine info

    Dosage 

    For each individual, the application of ketamine varies. The dosage of the drug varies depending on its application, whether it is taken intranasally, intravenously (IV), orally, or sublingually. The safest and easiest way for consuming ketamine is sublingually or orally. It is best and also advised that you take the ketamine treatment with the assistance and guidance of a medical professional, due to the few complications present [20] .

    The anti-depressant effect of the treatment normally wears off in a period of a few days to months. But, as long as it lasts, the impact of the drug on managing the symptoms of depression and providing relief can have long lasting improvements [21] .

    According to the study conducted by Andrade on the application and dosage of ketamine for depression, it was asserted that the usual amount of dosage administered for a person suffering from treatment resistant depression is 0.5 mg/kg. Some patients may respond to doses as low as 0.1 mg/kg, while others may require up to 0.75 mg/kg. The treatment takes around 40 to 100 minutes. The intravenous route is the commonly adopted route due to the effectiveness it endures. Oral, sublingual, transmucosal, intranasal, intramuscular, and subcutaneous routes are the other effective methods, respectively [22] .

    The sessions can vary from a single one to a course, depending on the severity of the condition. Some may feel some relief within the first session itself, whereas others may require sessions that can continue for weeks or even years in some cases.

    The ketamine dose, duration of the session, administration route, and frequency of administration of the drug are interlinked, that is, the eventual result is directly dependent on these factors [22] .

    Side Effects Of Ketamine For Depression 

    Excessive or uncontrolled use of the recreational drug can cause various adverse effects. The side effects include the following [23] .

    • Chest pain or discomfort
    • Confusion
    • Delusions
    • Loss of appetite
    • Dizziness, fainting
    • Sweating
    • Amnesia
    • Puffy or swollen eyelids, lips, or tongue
    • Hives, itching, or rash
    • Nausea
    • Difficulty thinking or learning
    • Nervousness or restlessness
    • Fast heartbeat, slow heartbeat or irregular heartbeat
    • Increased pressure in the brain and the eyes
    • Paleness, bluish lips, skin, or fingernails
    • Difficulty swallowing
    • Extreme fatigue or exhaustion
    • Convulsions
    • Slurred speech
    • Blurry vision
    • Inability to control eye movement
    • Difficulty breathing
    • Difficulty urinating or frequent urination
    • Cloudy or bloody urine[24]

    Risks Of Ketamine For Depression

    Relatively safe in medical settings, the anaesthetic does not depress the circulatory system or airway reflexes like the other anaesthetic medications. However, being a highly potent anaesthetic, the chemical is bound to have some risks associated with it[25] .

    Individuals who have a brain lesion or a tumour and glaucoma cannot receive ketamine medication, as it can increase the blood pressure and the pressure in the brain. And, the chemical has stronger effects in people over 65 years [26] .

    Also, if you have the following conditions, it is better to avoid the chemical; however you may consult a doctor to get detailed clarifications [27] .

    • An aneurysm 
    • Chronic alcohol addiction
    • Increased blood pressure
    • Thyroid disease
    • Mental illness
    • Acute alcohol intoxication
    • Coronary artery disease
    • Chest pain

    In Conclusion... 

    Ketamine's potential for abuse has raised various red flags in its approval. FDA is still looking over the authorization of ketamine as a legal depression treatment method, but the limitation arises due to the drug's psychedelic side effects such as hallucinations, euphoria and out of the body experiences.

    The risk of overdosing on ketamine is high, which again accords to uncertainty over the chemical's FDA approval [28] . One must be able to distinguish between the valid medical use of the chemical from the non-medical, recreational use. Long term recreational usage of the drug will result in serious psychological damage and death, even.

    With Johnson & Johnson and Allergan religiously studying and analysing the effects of ketamine on depression and its symptoms, one can hope that in the near future the studies can make a difference in the use and abuse of the chemical - thereby helping the millions of people suffering from the silent killer, depression.

    View Article References
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    2. [2] Kohrs, R., & Durieux, M. E. (1998). Ketamine: teaching an old drug new tricks.Anesthesia & Analgesia,87(5), 1186-1193.
    3. [3] Sinner, B., & Graf, B. M. (2008). Ketamine. InModern Anesthetics(pp. 313-333). Springer, Berlin, Heidelberg.
    4. [4] Hirota, K., & Lambert, D. G. (1996). Ketamine: its mechanism (s) of action and unusual clinical uses.
    5. [5] Harper, T. D. (2007). Perioperative uses of low-dose ketamine for pain management.Plastic Surgical Nursing,27(2), 98-101.
    6. [6] Prommer, E. E. (2012). Ketamine for pain: an update of uses in palliative care.Journal of Palliative Medicine,15(4), 474-483.
    7. [7] Gilbert, P. (2016).Depression: The evolution of powerlessness. Routledge.
    8. [8] Chukhraev, N., Vladimirov, A., Zukow, W., Chukhraiyeva, O., & Levkovskaya, V. (2017). Combined physiotherapy of anxiety and depression disorders in dorsopathy patients.Journal of Physical Education and Sport,17(1), 414.
    9. [9] Karp, D. A. (2016).Speaking of sadness: Depression, disconnection, and the meanings of illness. Oxford University Press.
    10. [10] Asen, E. (2018).Systemic Couple Therapy and Depression. Routledge.
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    12. [12] Larkin, G. L., & Beautrais, A. L. (2011). A preliminary naturalistic study of low-dose ketamine for depression and suicide ideation in the emergency department.International Journal of Neuropsychopharmacology,14(8), 1127-1131.
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    14. [14] Glue, P., Gulati, A., Le Nedelec, M., & Duffull, S. (2011). Dose-and exposure-response to ketamine in depression.Biological psychiatry,70(4), e9-e10.
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    17. [17] Newport, D. J., Carpenter, L. L., McDonald, W. M., Potash, J. B., Tohen, M., Nemeroff, C. B., & APA Council of Research Task Force on Novel Biomarkers and Treatments. (2015). Ketamine and other NMDA antagonists: early clinical trials and possible mechanisms in depression.American Journal of Psychiatry,172(10), 950-966.
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    19. [19] Levitt, A. (2018, July 24). I tried ketamine to treat my depression. Within a day, I felt relief [Blog post]. Retrieved from https://www.vox.com/first-person/2018/7/24/17603616/depression-treatment-severe-ketamine-special-k
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    Story first published: Monday, February 11, 2019, 12:00 [IST]
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