When Traditional Treatments Fail: How Ketamine Therapy Can Help

Antidepressants are commonly prescribed medications that treat not just major depressive disorder (MDD), but also bipolar disorder, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD), among other mental health conditions. They’re also used to treat chronic pain conditions like complex regional pain syndrome and migraine.

But what happens if the medications don’t work?

At the office of Dr. Michael Kullman, we offer ketamine infusion therapy for those people who don’t respond or don’t respond well to traditional antidepressants. If you fall in this category, known as treatment-resistant depression (TRD), here’s how ketamine can help.

Antidepressants at a glance

Traditional antidepressant medications usually target the pathway for serotonin, a neurotransmitter in the brain known to be related to mood. These drugs fall into several categories and include:

• Selective serotonin reuptake inhibitors (SSRIs): raise serotonin levels in the brain, improving mood
• Serotonin-norepinephrine reuptake inhibitors (SNRIs): raise both serotonin and norepinephrine levels, helping improve mood, stress, and alertness
• Tricyclic antidepressants: increase serotonin and norepinephrine, but also affect other parts of the brain and body

It generally takes six to eight weeks for the medication to build up to a therapeutic level; if it doesn’t work, the doctor moves on to the next drug in the queue, which also takes about six to eight weeks to determine if it’ll be effective.

Not everybody responds the second time around, either. Approximately 30% of people diagnosed with MDD who’ve tried at least two antidepressants for the required six to eight weeks each don’t respond to the effects of either. They’re said to have TRD.

What is ketamine, and how can it help TRD?

Ketamine is a dissociative anesthetic, originally used in veterinary medicine, then on the battlefield and in operating rooms. It’s FDA-approved for use as an anesthetic but is used off-label to treat depression, especially TRD.

Researchers aren’t exactly sure how ketamine functions in the brain, but they do know it works on the glutamate system, not the serotonin system targeted by most antidepressants. Glutamate is known to be involved in mood and pain regulation. As a result, it may be able to address TRD – or chronic pain – through another mechanism.

In addition, it’s fast-acting — patients may see results within 24 hours or so, meaning a rapid de-escalation of suicidal thoughts and actions after taking the drug.

Ketamine is available either as an IV infusion or as a nasal spray (Spravato®), and it’s administered in a clinical setting because of its sedating effects. Patients generally need a series of treatments for the effects to be lasting.

Both routes are effective, too. In one study, 70% of patients with TRD who received the nasal spray improved, compared with just over 50% in the control group.

If you’ve tried traditional antidepressants with no benefit, ketamine therapy may be the answer. Learn more about ketamine therapy or schedule an evaluation by calling our office at 914-465-2882 or booking an appointment online.