Ketamine

Ketamine, traditionally used as an anesthetic, has garnered attention since the early 2000s for its potential as an antidepressant. Unlike traditional antidepressants such as SSRIs, ketamine operates through a distinct mechanism, although researchers continue to investigate its precise workings. Its unique approach has shown significant promise in effectively addressing depression, particularly in cases where conventional treatments have proven ineffective.

At low doses, ketamine triggers an increase in glutamate, an excitatory neurotransmitter that promotes the development of brain synapses. This surge in glutamate encourages stimulation, strengthening, and restoration of neural connections within brain regions affected by depression. Consequently, the enhanced neuronal activity fosters substantial improvements in brain circuitry and function previously inhibited by depressive symptoms.

Researchers have investigated molecular changes associated with ketamine treatments, particularly in relation to G proteins. Individuals with depression often exhibit an accumulation of inactive G proteins. SSRIs function by activating these G proteins, rendering them useful. Ketamine accelerates this activation process significantly, inducing G proteins to become active within minutes rather than weeks and sustaining their activity for extended periods. This rapid and prolonged activation likely influences mood, thought patterns, and cognition.

Additionally, ketamine’s antidepressant effects may extend beyond G protein activation. For instance, it may reduce inflammatory signals associated with mood disorders and enhance cellular communication in specific brain regions. Ketamine is believed to operate through multiple mechanisms simultaneously, although much remains to be elucidated regarding its comprehensive therapeutic actions.

• Ketamine is at a much lower dose when given for depression when compared to a dose for anesthesia.
• Ketamine has addiction potential. It’s important to understand this addiction potential when deciding on treatment. If there is a history of substance abuse, such as alcohol or drugs, it’s probably best to avoid ketamine.
• Due to Ketamines speed of action when IV (racemic) ketamine works, people usually respond to it within the first three infusions. If a person has no response at all, further infusions are unlikely to help. Instead, it’s probably best to try another modality of treatment.
• Patients who experience some relief from depression within one to three ketamine treatments are probably likely to extend these positive effects if the treatment is repeated several more times. The subsequent sessions may help lengthen and strengthen the beneficial effects of ketamine.
• Many psychiatrists offer eight treatments initially. After eight treatments the patient and doctor decide the next step or course of action.
• Currently Boca Raton Psychiatry and Delray Beach Psychiatry do not offer ketamine treatment.

• Ketamine infusions administered by an IV. A much smaller dose compared to an anesthetic dose. Dosing is based on height, weight and medical history
• Spravato, an FDA-approved Ketamine nasal spray
• Dissolvable tablets
• Intramuscular Injection