A New Drug to Treat Depression: Ketamine

Depression is the most common psychiatric disease in our country and all over the world, and it significantly affects the physical and mental health of the person. In addition to causing great suffering, it is a serious disease that reduces the quality of life, impairs occupational, academic and social functionality, and can have consequences such as chronicity and suicide.

It is one of the most common diseases in the world, causing the most disability and causing the highest burden of disease in hospitals. In addition to its individual effects, it causes serious social and economic problems.

According to the data of the World Health Organization, it has been reported that approximately 4.4% of the world population, that is, more than 300 million people, are depressed. The lifetime risk of getting sick was found to be 20-26% in women and 8-12% in men. In other words, approximately one out of every five people will be depressed at least once in their lifetime.

Depression is a highly recurrent illness. Depression recurs in more than half of the patients. After each relapse, the probability of relapse increases. In addition, after relapses, resistance to treatment gradually increases, treatment becomes more difficult and the response time to treatment is delayed.

Treatment-resistant depression is used to describe patients who do not respond to treatment despite using at least 2 different antidepressants in sufficient dose and duration (at least 6 weeks). Approximately one third of patients do not respond adequately to current drug treatments. Approximately one in five patients, depression becomes chronic.

What is Ketamine?

Ketamine has been used in anaesthesia since the 1970s due to its analgesic and anaesthetic effects. Studies conducted in recent years have found that lower doses of Ketamine than those used in anaesthesia may be effective in cases of treatment-resistant depression.

Studies have shown that depressive symptoms begin to regress within hours after ketamine treatment is administered, which has increased the interest in ketamine treatments in recent years. The first effects of classical antidepressants begin to appear after 2-3 weeks and it is necessary to wait 4-6 weeks for the full effect to occur. In ketamine treatments, the antidepressant effect begins to be seen from the first day.

Despite this very important effect, the fact that the effect starts to regress after 1-2 weeks after a single dose of ketamine is administered in the studies is seen as the biggest disadvantage of this treatment. There are also studies reporting that the effect lasts longer with repeated applications.

Ketamine acts differently and much faster than conventional antidepressants. It acts through glutamate, the main stimulating chemical that provides communication between nerve cells in the brain.

Although the mechanism of antidepressant action of ketamine is still not fully known, it is thought to increase the maturation of nerve cells in the brain and the connections between them. In addition, it has been suggested that it provides rapid antidepressant effects by affecting signal transmission in brain cells.

What is Ketamine Infusion Therapy (KIT)?

Ketamine is administered intranasal, intramuscularly, intravenously and orally in the treatment of depression.

Ketamine Infusion Therapy is a new treatment method based on the intravenous administration of a drug called Ketamine, in hospital conditions, over a period of approximately 45 minutes, to patients with Treatment-Resistant Depression or severe suicidal thoughts.

With Ketamine Infusion Therapy, patients with treatment-resistant depression or suicidal thoughts who do not respond to standard treatments such as Antidepressant DrugsCognitive Behavioural Therapy or Electroconvulsive Therapy can see a rapid improvement in their symptoms.

In approximately half of the patients, regression in depressive symptoms can be observed hours after a single dose of Ketamine Infusion Therapy is administered, and it is observed that the antidepressant effect peaks within 24 hours and this effect continues for 1-2 weeks. These effects can vary from person to person and not everyone has the same positive results.

Despite this rapid effect of Ketamine Infusion Therapy, the biggest disadvantage is that the effect decreases significantly after the 1st week. It is observed that this effect can last longer with repeated applications.

Who Can Benefit?

Patients with treatment-resistant Major Depression, Bipolar Depression or severe suicidal thoughts and who do not achieve adequate improvement despite at least two different antidepressant or mood-stabilizing drugs and electroconvulsive therapy may benefit from this treatment.

The intranasal spray form of ketamine was approved for use in the treatment of Treatment-Resistant Depression by the US Food and Drug Administration (FDA) in 2019.

Ketamine Infusion Therapy has not yet become one of the standard treatments for depression. Despite its promising effects, data on its success rate are still limited as it is a new treatment method. However, increasing studies in recent years show that ketamine treatments may have an important place in the treatment of depression.

There are studies reporting that Ketamine Infusion Therapy can provide positive results with rapid effect in people with a high risk of suicide. However, studies on this subject are not yet at a sufficient level to evaluate the efficacy of treatment.

To Whom It Is Not Applicable?

  • Those with psychotic symptoms
  • Those with Alcohol-Substance Use Disorder,
  • Those with serious liver, lung, heart, kidney disease,
  • Those with uncontrolled high blood pressure,
  • It does not apply to people with significant brain diseases.

How is Ketamine Infusion Therapy Applied?

Before Application

  • Before your first Ketamine treatment, your suitability for the procedure will be evaluated by our psychiatrist. For this purpose, some psychiatric tests with a psychiatric examination will be applied and a psychiatric evaluation will be made.
  • If it is determined that you are suitable for the procedure from a psychiatric point of view, after being examined by our anaesthesiologist, a physical examination, basic blood tests and EKG will be performed to evaluate your general medical condition. If necessary, your internal medicine consultation will be requested.
  • Pre-treatment examinations and tests are done to evaluate your safety and whether this treatment is the right treatment for you. Your doctor will talk to you about the benefits and risks of Ketamine and ask you to sign a consent form.

Ketamine Infusion Therapy Application

  • The treatment team consists of a Psychiatrist, Anaesthesiologist and a nurse.
  • The application will be made in the Ketamine Infusion Therapy unit.
  • The drug called ketamine will be administered intravenously in a slow and long time, by a method called infusion, in the serum.
  • In order for the drug to be administrated, a vascular access will be established in one of your arms. Your blood pressure, heart rate and rhythm, and your blood oxygen level will be monitored throughout the procedure.
  • Under the supervision of an Anaesthesiologist and a Psychiatrist, you will receive Ketamine through a vein in your arm in a session lasting approximately 45 minutes.
  • Patients are not anesthetized during the application. The application is done consciously while lying on the bed. There is no pain during the procedure.
  • Treatment is carried out in two or three sessions per week. Although 6 sessions are applied on average, the number of sessions may vary according to the treatment response. If necessary, maintenance sessions can be applied once a week to maintain the effect.
  • Although a single dose of Ketamine Infusion Therapy can be applied, it has been reported in studies that repeated doses may provide a longer duration of effect. Although standard protocols for Ketamine Infusion Therapy have not yet been fully developed all over the world, it has been found more functional and effective to apply 2 or 3 sessions per week and an average of 6 sessions.

After Application

  • In the first three hours after the application, your heart rate and blood pressure will be measured and recorded at regular intervals in order to monitor the effects of Ketamine.
  • At the same time, the effect of the treatment will be evaluated. For this purpose, the severity of depression, suicidal thoughts and undesirable effects will be observed and recorded.
  • If you are an outpatient, you can be discharged from the hospital under the supervision of a member of your family or a relative if your condition is suitable at the end of the follow-up period.
  • It is not appropriate to drive home, consume alcohol on the same day, make important decisions, or drive a motor vehicle.
  • Continuing your antidepressant medications together with ketamine treatment will increase the effectiveness of the treatment.

What are the Undesirable Effects of Ketamine Infusion Therapy?

Ketamine therapy has potential side effects, but these are usually mild and short-lived. You may experience all or some of the side effects of the drug or not be seen at all.

Rare, unknown or unforeseen side effects may also occur. Side effects usually depend on the dose of the drug and how quickly it is administrated. These side effects usually go away on their own. No permanent side effects were reported. These side effects are not seen in all patients treated with Ketamine Infusion Therapy, and in patients with side effects, these effects disappear after a few hours.

  • Nausea-vomiting, increased salivation, dizziness, blurred vision, feeling light-headed, feeling “you are out of your body”, impaired motor skills
  • Abnormal body sensations and/or feeling strange or unreal
  • Vivid dreams/nightmares, changes in perception of stimuli – hallucinations (hearing voices, seeing things)
  • Headache, difficulty concentrating, restlessness
  • Heart rate and blood pressure changes, irregular heartbeat
  • Allergic reactions

The information on this page has been prepared by the Moodist Psychiatry and Neurology Hospital Medical Team.

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