Depression can be chronic and long-lasting, and many sufferers try several different treatments and medications before finding one that works for them. Typically, depression treatment includes antidepressant medication, often in combination with behavioral therapy. Although antidepressants can be life-changing for many people with depression, some people may experience delays or difficulty finding effective treatment.

Some of the criticisms of traditional antidepressant treatments are:

  • Response to medication varies from person to person
  • Negative side effects
  • Slow to be effective

To address some of these shortcomings, researchers and clinicians have trialed other types of treatments. Recently, ketamine treatment for depression has gotten attention as an alternative to other slower-acting antidepressants.

What Is Ketamine?

Ketamine was originally used as an anesthetic medication. More recently, it has been used as a fast-acting antidepressant, with reports suggesting it may be effective in as little as a few hours, and its effects may last for days or weeks. Ketamine therapy is beneficial for people who have not responded to other forms of treatment and are thought to have treatment-resistant depression. For people with severe or treatment-resistant depression, or with an immediate risk of suicide, ketamine therapy may be a life-saving treatment option.

How Is Ketamine Used to Treat Depression?

Most antidepressant medications are taken in pill form; ketamine, however, is most frequently delivered intravenously. It is typically used in cases of treatment-resistant depression, where multiple other attempts to alleviate depression symptoms have been unsuccessful.

Before ketamine is prescribed, a detailed medical history is collected that typically includes, among other pieces of information, details about any previous psychiatric illness and medications taken. Ketamine for depression is typically administered for 40 minutes, three times per week in a clinical setting. Patients are monitored closely for any signs of an adverse reaction.

History of Ketamine Treatment

Ketamine’s primary medicinal use has been as an anesthetic, and it was used heavily for pain management for soldiers during the Vietnam war. At some doses, ketamine can cause hallucinogenic or dissociative features and has been used to “model” schizophrenia in research settings.

Because of these side effects, ketamine (often referred to as “K” or “Special K”) has often been used and abused recreationally. It became a popular recreational drug in the 1970s and was common in rave culture. Recreational use and abuse of ketamine have been associated with cardiovascular, gastric and urinary health problems.

More recently, there has been increasing research into the antidepressant effects of ketamine. In 2000, an important study showed that participants who had been given a low-dose infusion of ketamine had significant improvements in their depression symptoms compared to those who had an infusion of a saline solution. Since then, there have been many more clinical trials evaluating the use of ketamine in depression. These trials have demonstrated the effectiveness of the drug, and ketamine infusions or injections are now offered as treatment options in some cases of depression. Most recently, a similar drug called esketamine has also been approved for use in clinical settings.

Ketamine vs. Traditional Antidepressants

Ketamine is thought to be effective in cases where other types of treatment have failed to provide significant improvements in depression symptoms because it targets different biological mechanisms than other depression treatments. Traditional antidepressants target the monoamine system, a group of chemicals that include serotonin or dopamine, and can take weeks to be effective. In contrast, ketamine acts on glutamate, which can be effective almost immediately. This difference can be life-saving for those experiencing suicidal ideation.

Ketamine also differs from traditional antidepressants when it comes to its side effect profile. While conventional antidepressants may have unpleasant side effects, the effects of ketamine may be more intense, acute or severe, with a heightened risk of abuse.

Feelings of depression or anxiety can lead to suicidal thinking. If you or a loved one is experiencing suicidal thoughts or tendencies, call the National Suicide Prevention Hotline at 1-800-273-8255.

Ketamine Side Effects

Although there have been many therapeutic benefits to the use of ketamine, there are also several side effects that warrant consideration. For example, adverse effects may include:

  • Psychiatric conditions, including schizophrenia symptoms or mania
  • Increase in blood pressure
  • Feeling intoxicated or having lowered inhibition
  • Disruptions to memory
  • In rare cases, toxicity

In many cases, these symptoms, much like the antidepressant effects of ketamine, appear during ketamine administration and wear off within a short time. However, it’s important to consider these side effects when deciding on depression treatment.

As a result of the rapid antidepressant effects and some of the potential sensory-altering effects, ketamine is sometimes used recreationally or abused. Because of this, a prescription for ketamine may not be provided to those with a history of substance use problems.

FDA Approval of Esketamine

Given the challenges of adequately addressing treatment-resistant depression, there’s great interest in making ketamine or similar drugs available to the public. As a result, many trials have tested the effects of esketamine, a drug similar to ketamine. Esketamine has been tested for use through a nasal spray, rather than the more burdensome intravenous delivery. Trials have shown that it is effective in rapidly alleviating depression symptoms.

In 2013, the Food and Drug Administration (FDA) approved the use of esketamine for treatment-resistant depression, particularly in cases where suicide is an imminent risk. The FDA approval of a nasal spray for depression shows important progress in making the drug more accessible for those who may urgently need it. However, while the drug has been approved, it is still under restricted distribution to prevent abuse and is only available from certified doctors and clinics.

Cost of Ketamine Treatment

The cost of ketamine can be a significant barrier to access. Just a single dose of esketamine can cost $500 or more, with additional costs for properly trained personnel or appropriate equipment. Given that the benefits of the drug may be fairly short term, the price of repeated ketamine treatment may be unaffordable for many people.

The Future of Ketamine Treatment for Depression

Use of ketamine can be life-saving for severely depressed patients. However, questions remain surrounding the long-term safety and health outcomes of extended ketamine use. There is also ongoing research to examine whether alternative drugs with similar effects may be safe for use, and may reduce the risk of abuse associated with ketamine.

If you or someone you care about is misusing ketamine, contact The Recovery Village today. We have qualified, caring staff that can help address ketamine addiction and other substance use disorders.

Sarah Dash
By – Dr. Sarah Dash, PHD
Dr. Sarah Dash is a postdoctoral research fellow based in Toronto. Sarah completed her PhD in Nutritional Psychiatry at the Food and Mood Centre at Deakin University in 2017. Read more

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Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.