In my career as an anesthesiologist, I’ve used ketamine thousands of times as an adjunct to my anesthesia plan. This drug, developed decades ago, has been used by anesthesia and veterinary practitioners to place humans and animals in a ‘dissociative state,” a frame of consciousness that straddles the borders of sedation, pain relief and a blissful “I don’t care” attitude.
Now, it has been found that this agent, when administered intravenously or by nasal aerosol, has been remarkably effective at reducing deep depression and anxiety in a rapid fashion.
This has been described as perhaps the most exciting development in psychopharmacology in years. Drugs that normally took weeks or even months to effect a positive change in mood and emotional outlook now appear to have taken a back seat to ketamine. The use of ketamine in clinical psychiatry has even been purported to rapidly reverse suicidal behavior in some patients who have not responded to other medications.
Ketamine, which is neither narcotic like morphine, nor sedative like Valium, is truly in a class by itself. It can be given intramuscularly, intravenously and by nasal spray. The newer uses for it to treat anxiety and depression are given intravenously and by nasal spray. It has been found that a dose of 0.5 mg per kg of body weight given nasally can have a profound and rapid effect on improving mood and reducing anxiety.
One drawback, however, is that the effects may be short lived—days or weeks, unlike traditional SSRI, SNRI and other medications that reach a steady state in the body and last for as long as the drug is taken. Also, ketamine therapy may need to be repeated at regular, more frequent intervals.
Side effects can include fast heart-beat, a rise in blood pressure, vivid dreams, excessive salivation and dysphoria, which is usually short-lived.
Certainly, from the studies that are being conducted, ketamine therapy is showing promise in psychiatric care that has been wanting due to lack of effective rapid and profound therapy. My best advice to those considering ketamine therapy is to consider the following:
- Repeated dosing may be needed.
- It’s best to find a study or center using this therapy that is affiliated with a teaching hospital or medical school.
- Its use should be reserved for rapid relief of moderate-to-severe depression and anxiety, or disorders resistant to other therapies.
- Any clinic involved in this therapy should have accreditation, adequately trained staff (anesthesia personnel are ideal) and safety measures to monitor the patient.
- It can be a “quick fix,” but the underlying condition still needs ongoing treatment.
So, yes…ketamine may be the rapid, short-term answer psychiatry has been looking for moderate-to-severe and/or treatment-resistant depression and anxiety. But more studies need to be done. Let’s hope this weapon in the fight for better mental health becomes better understood and tweaked to a higher degree of effective application.
For more with Dr. Sherer, click here for his podcast and video interviews, or purchase his memoir, The House of Black and White: My Life with and Search for Louise Johnson Morris.