A New Drug to Treat Depression: Ketamine
Depression It is the most common psychiatric illness in our country and all over the world and significantly affects the physical and mental health of the person. In addition to causing great suffering, it is a serious illness that reduces quality of life, impairs professional, academic and social functionality, and can have consequences such as chronicity and suicide.
It is one of the most prevalent, disabling and burdening diseases worldwide. In addition to its individual effects, it causes serious social and economic problems.
According to the World Health Organization, approximately %4.4 of the world's population, i.e. more than 300 million people, are depressed. The lifetime risk of becoming ill was found to be -26 for women and %8-12 for men. This means that approximately one in five people will be depressed at least once in their lifetime.
Depression has a high tendency to recur. Depression recurs in more than half of patients. After each relapse, the likelihood of becoming depressed again increases. In addition, after relapses, resistance to treatment increases, treatment becomes more difficult and response time to treatment is delayed.
Treatment-resistant depression is used to describe patients who do not respond to treatment despite the use of at least 2 different antidepressants in adequate doses and duration (at least 6 weeks). Approximately one third of patients do not respond adequately to current medication. In approximately one in five patients, depression becomes chronic.
What is Ketamine?
Ketamine has been used in anesthesia since the 1970s because of its analgesic and anesthetic effects. Recent studies have found that lower doses of ketamine than those used in anesthesia may be effective in cases of treatment-resistant depression.
The observation that depressive symptoms begin to regress within hours after ketamine treatment has increased the interest in ketamine treatments in recent years. The first effects of classical antidepressants start 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 starts to be seen from the first day.
Despite this very important effect, the fact that the effect starts to regress significantly after 1-2 weeks after a single dose of ketamine administration is considered to be the biggest disadvantage of this treatment. There are also studies reporting that the effect lasts longer with repeated applications.
Ketamine works differently and much faster than conventional antidepressants. It works through glutamate, the main excitatory chemical in the brain that enables communication between nerve cells.
Although the antidepressant mechanism of 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 transduction in brain cells.
What is Ketamine Infusion Therapy (KIT)?
Ketamine is administered intranasally, intramuscularly, intravenously and orally to treat depression.
Ketamine Infusion Therapy, It is a new treatment method based on the intravenous administration of the drug Ketamine to patients with Treatment-Resistant Depression or severe suicidal thoughts in hospital conditions in about 45 minutes.
With Ketamine Infusion Therapy Antidepressant drugs, Cognitive Behavioral Therapy or Electroconvulsive Therapy Patients with treatment-resistant depression or suicidal thoughts who do not respond to standard treatments, such as those with depression or suicidal thoughts, may experience a rapid improvement in their symptoms.
Single dose in about half of patients Ketamine Infusion Therapy Within hours after administration, depressive symptoms may regress, the antidepressant effect peaks within 24 hours and lasts for 1-2 weeks. These effects may vary from person to person and not everyone may experience 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 be maintained for a longer time with repeated applications.
Who Can Benefit?
Patients with treatment-resistant Major Depression, Bipolar Depression or severe suicidal ideation who have failed to achieve adequate improvement despite at least two different antidepressants or mood stabilizers and electroconvulsive therapy may benefit from this treatment.
The intranasal spray form of ketamine was approved by the US Food and Drug Administration (FDA) in 2019 for the treatment of Treatment-Resistant Depression.
Ketamine Infusion Therapy has not yet become a standard treatment for depression. Despite its promising effects, data on its success rate is still limited as it is a new treatment modality. 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 high suicide risk. However, studies on this subject are not yet sufficient to evaluate treatment efficacy.
To whom is it not applicable?
- With psychotic symptoms,
- Alcohol-Substance Use Disorder,
- Serious liver, lung, heart, kidney disease,
- Uncontrolled high blood pressure,
- It is not administered to people with significant brain diseases.
How is Ketamine Infusion Therapy Administered?
You will receive general anesthesia. Therefore, no food or water should be given after the night before. You may have a short physical examination. This is mainly to check your heart and lungs.
Before Implementation
- Before your first Ketamine treatment, you will be assessed by our Psychiatrist to see if you are suitable for the procedure. This will include a psychiatric examination, some psychiatric tests and a psychiatric evaluation.
- If it is decided that you are psychiatrically suitable for the procedure, you will be examined by our anesthesiologist, followed by a physical examination, basic blood tests and ECG to assess your general medical condition. If deemed necessary, your internal medicine consultation will be requested.
- Pre-treatment examinations and tests are carried out to assess your safety and whether this 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 Administration
- The treatment team consists of a Psychiatrist, Anesthesiologist and a nurse.
- The application will be performed in the Ketamine Infusion Therapy unit.
- The medicine called ketamine will be given slowly and over a long period of time through a vein in serum, using a method called infusion.
- An IV will be started in one arm so that the medicine can be administered. Your blood pressure, heart rate and rhythm and blood oxygen level will be monitored during the procedure.
- Under the supervision of an Anesthesiologist and a Psychiatrist, you will take Ketamine through a vein in your arm in a session that will last about 45 minutes.
- Patients are not put to sleep during the application. The application is performed while lying in bed and conscious. There is no pain or pain during the procedure.
- Treatment is performed in two or three sessions per week. Although an average of 6 sessions are applied, the number of sessions may vary depending on 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 administered, studies have reported that repeated doses may provide a longer duration of effect. Although standard protocols regarding Ketamine Infusion Therapy have not yet been fully established all over the world, it has been found to be more functional and effective to apply 2 or 3 sessions per week with an average of 6 sessions.
After Implementation
- In the first three hours after administration; your heart rate and blood pressure will be measured and recorded at regular intervals 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 unwanted effects will be observed and recorded.
- If you are an outpatient, you may be discharged from the hospital at the end of the follow-up period under the supervision of a member of your family or a relative, if appropriate.
- It is not appropriate for you to drive home, consume alcohol, make important decisions or operate a motor vehicle on the same day.
- Continuing your antidepressant medication with ketamine treatment will increase the effectiveness of the treatment.
What are the Undesirable Effects of Ketamine Infusion Therapy?
Ketamine treatment has potential side effects, but they are usually mild and short-lived. You may or may not experience some or all of the side effects of the medicine.
Rare, unknown or unforeseen side effects may also occur. Side effects usually depend on the dose of the medicine and how quickly it is given. These side effects usually disappear spontaneously. No permanent side effects have been reported. Not all patients receiving Ketamine Infusion Therapy experience these side effects and in those who do, they largely disappear after a few hours.
- Nausea and vomiting, increased salivation, dizziness, blurred vision, lightheadedness, “out of body” feeling, 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 Medical Team of Private Moodist Hospital.