Major depression can be a debilitating disorder, and it is one of the leading causes of disability. Although we have learned more about depression in recent years, it remains a complicated illness that can be extremely difficult to treat in some people. This has led researchers to look into new treatment methods and medications that can offer hope for those living with depression. One of the newer medications being used to treat depression is ketamine.
What Is Ketamine?
Ketamine is a short-acting anesthetic. It is used on humans and in veterinary medicine. In 1999, it became a Schedule III non-narcotic substance under the Controlled Substances Act. It is abused for its hallucinogenic and dissociative effects. Unfortunately, ketamine is also used to facilitate sexual assaults.
How Is Ketamine Administered for the Treatment of Depression?
In 2019, the FDA approved the S(+) enantiomer of ketamine (esketamine) nasal spray version (Spravato) for treatment-resistant depression. Racemic ketamine infusions are used off-label for depression. Ketamine is still not a first-line treatment for depression, and the treatment must occur in a Risk Evaluation, and Mitigation Strategy (REMS) certified clinic or treatment center.
With esketamine, the patient self-administers the nasal spray in 3 doses spaced 5 minutes apart under the supervision of a healthcare provider at a REMS-certified clinic. The patient is monitored during and for two hours after administration. The healthcare provider will determine when the patient can leave the clinic safely. The nasal spray cannot be taken out of the clinic. How Does Ketamine Relieve Symptoms of Depression?
Ketamine works similarly to our conventional antidepressants. Conventional antidepressants increase levels of neurotransmitters, including norepinephrine, dopamine, and serotonin. Ketamine works by increasing levels of a different neurotransmitter called glutamate. Since glutamate is the most abundant neurotransmitter in the brain, ketamine can have a greater impact on more brain cells at a time.
Benefits of Ketamine use
One significant benefit of ketamine use is how quickly patients can start to feel better. Some patients can experience an improvement in symptoms within a matter of hours rather than waiting for weeks and hoping symptoms improve. With traditional medications used to treat depression, it can take several weeks to establish the right dosage for medication, and patients feel frustrated. Ketamine is used with conventional antidepressants since it acts rapidly to bring symptom relief during the time it takes for the antidepressant to start working.
While some antidepressants can actually increase suicidal thoughts in the early phase of treatment, ketamine decreases suicidal thoughts. According to the Johns Hopkins Medicine article, Esketamine for Treatment-Resistant Depression, It is the only medication for depression that is proven to reduce suicidal thoughts.
Also, according to the article Esketamine for Treatment-Resistant Depression, research suggests untreated depression can cause brain damage over time. It is even a risk factor for dementia. However, ketamine may counteract this by reversing stress-related damage.
Risks of Ketamine Use
While ketamine can be effective for treatment-resistant depression, it is not a perfect treatment. There are risks when using ketamine for depression, including:
- Psychological dependence
- Increased suicidal thoughts and actions in some people
- Fetal harm in pregnant women
- Temporary increase in blood pressure
- Psychological dependence
Will Insurance Cover Treatment?
Spravato may be covered by insurance depending on the plan and whether the plan’s criteria for the treatment have been met. Some criteria that might have to be met are:
- The patient must be 18 years old or older
- Diagnosis of major depressive disorder (MDD).
- Trial, failure, or contraindication of a designated number of antidepressant medications at the maximally tolerated dose for at least eight weeks. For example, United Healthcare’s criteria state trial, failure, or contraindication of 3 antidepressants in their criteria. Each insurance company may have slightly different criteria, which can change slightly from year to year.
- Initiation of a new oral antidepressant at the time Spravato treatment is started.
- The provider must submit a request with medical records for prior authorization (prior auth) review.
It is a good idea for patients to check their benefits coverage or call their insurance company’s member services department to determine whether or not Spravato is a covered benefit under their plan. The criteria established by insurance companies may also be found online by doing.
Hope for the Future
Even though the use of ketamine for depression is not currently administered in most patients with depression, it offers hope for the future. There is renewed hope that new, more effective medications may be discovered sooner rather than later. In addition, discovering that ketamine helps depression also holds out hope that there may be other medications already in use for other purposes that will be effective for treating depression.
Depression is one of the most common mental illnesses and a leading cause of disability. While many aspects of depression remain poorly understood, researchers are learning more about it and finding more ways to treat this disorder. At Sober Life, our partial hospitalization program (PHP), intensive outpatient program (IOP), and outpatient program (OP) offer treatment and hope. Through our PHP program, you will have access to psychiatric evaluation and continued medication management throughout the program. All of our outpatient programs cost significantly less than inpatient treatment and provide an easier transition back into everyday life. At each level of care, your care will be guided by an individualized treatment plan that is based on your unique strengths and needs. If you struggle with depression, there is hope for a happy, healthy life. Call Sober Life at (619) 542-9542 to learn more about how we can help.