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Will Ketamine Cure My Condition?
Over the past several years there has been growing interest in ketamine’s ability to cause rapid anti-depressant effects in patients with otherwise treatment-resistant major depressive disorder. Studies suggest that up to 70% of patients treated with ketamine may obtain symptom relief. Research in post-traumatic stress disorder, anxiety disorders, obsessive-compulsive disorder and bipolar disorder has illustrated ketamine’s potential to rapidly improve symptoms in a wide range of mental health conditions.
Despite ketamine’s potential as a “game changer” in the treatment of these mental health conditions, it is important to understand that ketamine will not cure your disease. There can be a tendency to view mental health and chronic pain conditions as different than other incurable diseases, such as diabetes mellitus or high blood pressure. While the specific medications and therapies may differ, the treatment approach is remarkably similar – how do we best reduce the disease burden of an incurable disease? In the case of diabetes, for example, optimal management involves not only medication but also lifestyle changes such as dietary adjustments. Likewise, for mental health and chronic pain conditions, there is seldom going to be a single pill or therapy that will completely eliminate symptoms. Rather, the most effective treatment plan involves a multi-modal approach, combining the benefits of numerous options (medication, therapy, lifestyle changes, etc.) to achieve a greater level of improvement than would be possible with any single treatment alone.
Ketamine therapy is best viewed within the concept of a multi-modal treatment plan. The goal is not to eliminate other treatment options, but rather to build upon them to achieve greater symptom relief.
Conditions Treated
Major Depressive Disorder
According to a national survey of over 36,000 US adults, the lifetime prevalence of major depressive disorder (MDD) is 20.6%, about 1 in 5 adults. Of those MDD cases, 39.7% were considered moderate and 49.5% severe. Given the high disease prevalence, there has been significant research into developing pharmacologic and non-pharmacologic treatments. Despite tremendous advances, clinical improvement may take 4-10 weeks and up to 35% of patients fail to respond to oral antidepressant medications. Moreover, patients that have not responded to two or more different drugs, referred to as “treatment-resistant depression”, have a significantly lower likelihood of responding to other oral antidepressants.
The majority of oral antidepressant medications work by increasing the level of serotonin, a chemical in the brain thought to regulate happiness, anxiety and mood. Low levels of serotonin have been associated with depression. Ketamine appears to work differently, blocking cell receptors controlled by glutamate, another chemical in the brain. This difference may explain its rapid onset of relief and effectiveness in cases of treatment-resistant MDD. Ketamine has also been shown to cause a rapid reduction in suicidal thoughts.
Post-Traumatic Stress Disorder
According to a national survey of over 5,600 US adults, the lifetime prevalence of post-traumatic stress disorder (PTSD) is 6.8%, about 1 in 15 adults. Trauma-focused psychotherapy is the first-line treatment for PTSD. Medication, however, can play an important role by reducing symptoms, which can improve patient engagement with therapy. For some patients, medication may be the only treatment option due to limited availability of psychotherapy.
Current medication options are limited – the only FDA-approved drugs from the treatment of PTSD are the selective serotonin reuptake inhibitors (SSRIs) sertraline and paroxetine. Unfortunately, these first-line medications have an overall response rate of only 60%, with only 20-30% of patients achieving complete remission. Furthermore, clinical improvement may take from 4-10 weeks. Second-line, off-label drugs, such as other SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs), antipsychotics, benzodiazepines and adrenergic-inhibiting agents may aid with certain symptoms, but overall are associated with significant non-response.
Research involving PTSD has shown that ketamine infusions are associated with a rapid reduction in symptom severity compared to benzodiazepines. Further, a study assessing the benefit of repeat infusions showed that patients who received a series of 6 infusion over 2 weeks experienced symptom relief for a median of 4 weeks after the infusions were complete.
Anxiety Disorders
According to a national survey of over 9,200 US adults, the lifetime prevalence of generalized anxiety disorder (GAD) was 5.7%, about 1 in 18 adults. The same survey found the lifetime prevalence of social anxiety disorder (SAD) to be 12.1%, about 1 in 8 adults.
In a series of studies looking at patients with treatment-resistant GAD or SAD, improvement in symptoms was observed within 1 hour of ketamine dosing and persisted for up to 1 week.
Obsessive-Compulsive Disorder
According to a national survey of over 2,000 US adults, the lifetime prevalence of obsessive-compulsive disorder (OCD) is 2.3%, about 1 in 42 adults. Serotonin reuptake inhibitors (SRIs) are currently the only FDA-approved medications for OCD. Unfortunately, these first-line drugs often provide limited symptom relief and can take 4-10 weeks to achieve clinical improvement.
In a study involving adult patients with near constant obsessions, 50% of patients who received a single ketamine infusion continued to meet criteria for treatment response one week after the infusion, versus 0% in the placebo group.
Bipolar Disorder
The lifetime prevalence of bipolar disorder (BD) is around 1%, about 1 in 100 adults. Most patients experience depression for a significant portion of their lives, and unfortunately, treatment resistance in BD appears to be even higher than in major depressive disorder (MDD). Several studies have repeatedly demonstrated a rapid antidepressant effect in around 50% of patients treated with a single ketamine infusion.
Chronic Pain Syndromes
Ketamine has been shown to provide symptom relief in several chronic pain syndromes, including fibromyalgia, complex regional pain syndrome (CRPS), neuropathic pain, spinal cord injury and headaches. For chronic pain conditions, we recommend contacting our office to schedule an appointment with Dr. Silva to assess your condition and discuss treatment options.
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