Ketamine is one of the most recent and promising options for the treatment of major depression. This anesthetic agent, in use for many years, has been demonstrated to be effective in rapidly alleviating depressive symptoms. Unlike the weeks or months for a response using conventional antidepressant medication, ketamine may provide results quickly, often within hours. Ketamine is most effective in helping alleviate symptoms of severe, treatment-resistant depression, and has been shown to be of help to those who have tried and failed other treatment options, such as medication, psychotherapy, and/or neuromodulation.
The Mount Sinai School of Medicine study published in Biological Psychiatry in 2014, showed that ketamine delivered via nasal spray produced similar robust results in the treatment of depression compared with intravenous ketamine infusion. In this small study, almost half of the patients in the trial receiving intranasal ketamine showed great reduction in depressive symptoms after just one day. This study has garnered much attention from the mental health community, both for its exciting results as well as the lower-risk use of intranasal versus intravenous application of ketamine. Intranasal application is also a shorter and more comfortable procedure.
Note: Intranasal ketamine has not been FDA-approved for the treatment of Major Depressive Disorder. Please contact us to discuss whether Ketamine Therapy may be an appropriate treatment for you.
Frequently Asked Questions
- How does ketamine differ in its methods of action when compared with typical antidepressant medications?
- How long is a ketamine treatment session?
- What are the benefits of choosing ketamine?
- How long does the antidepressant effect last? Do patients need to go back for another session?
- Is Ketamine Therapy a good alternative for patients who are fearful of the side effects associated with typical antidepressant medications?
- Are there any patients who would be excluded from receiving ketamine?
- What is the cost of treatment?
- Will treatment be covered by insurance and/or Medicare?
- Is Ketamine Therapy intended to replace antidepressant medications?
- What are the risks of Ketamine Therapy?
- What has ketamine been used for?
1. How does ketamine differ in its methods of action when compared with typical antidepressant medications?
Ketamine is a potent NMDA receptor antagonist, which affects the brain’s response to the excitatory neurotransmitter glutamate. NMDA receptors are implicated in the brain’s plasticity, or ability to adapt to change. Although exact mechanisms are not yet clear, it is thought that the blocking of this receptor and resulting increase of intercellular glutamate rejuvenates neuronal growth and promotes activity, contributing to the alleviation of the previously down-regulated brain circuits involved in the depression.
2. How long is a ketamine treatment session?
Each treatment consists of ketamine administered intranasally through a mucosal atomization device, with five sprays delivered over a 30-50 minute period. Patients will then be observed for a period of at least 30 minutes, or as long as is deemed necessary.
3. What are the benefits of choosing intranasal ketamine?
- Fast-acting: for those patients who respond, results will be generally seen within 24 hours, sometimes in as short as 60 minutes.
- Effective: it has been demonstrated to be effective for many patients with treatment-resistant depression, who had not responded to antidepressant medications or other interventions. In clinical trials, almost half of patients had a significant reduction of depressive symptoms after the first treatment.
- Safe: 100% safety record with no significant complications or issues. Less complexity and fewer potential problems than intravenous ketamine administration.
- Side effects: low risk for any serious side effects with no antidepressant drug interactions. The most common side effects are temporary feelings of drowsiness and a sense of depersonalization.
- Significantly reduced cost compared with intravenous administration.
4. How long does the antidepressant effect last? Do patients need to go back for another session?
Studies indicate that those patients who respond will benefit for, on average, a period of only 5-10 days. However, some patients report benefits lasting 4-6 weeks, and on a rare occasion up to 9-10 months. It is my opinion that ketamine is best used as a “rescue” drug for those with severe depression and suicidal thinking. It is most effective as a complement to other treatments rather than mono therapy. The necessity for subsequent sessions will be determined by an individual’s response to the initial treatment. We will discuss future needs in length and suggest future appropriate treatment alternatives, if needed. General present-day consensus is that 3 treatments, e.g. M-W-F is the optimal schedule to begin ketamine therapy. There is no need for more than 3 treatments that first week and a response can be seen at any time during that first initial trial. However, if results are not seen within several days of the 3rd treatment, it is highly unlikely that the individual will benefit from any additional future ketamine treatments.
5. Is Ketamine Therapy a good alternative for patients who are fearful of the side effects associated with typical antidepressant medications?
Ketamine has been shown to be most useful for those with refractory depression who have tried different treatments, such as medication, and either failed to respond or experienced intolerable side effects. Ketamine should not be considered as a first-line treatment for depression, but is a viable option to consider for those who have not experienced relief from medication. It may also be effective for reducing suicidal thinking. At this time, the use of ketamine for the treatment of depression is entirely investigational and experimental.
Like any treatment option, patients and clinicians should work together to find the most appropriate treatment option for each patient.
6. Are there any patients who would be excluded from receiving ketamine?
Current contraindications for Ketamine Therapy include patients with high blood pressure and/or a history of heart problems, or any previous allergic reactions to ketamine.
7. What is the cost of treatment?
All patients must undergo a psychiatric evaluation with Dr. Boyadjis prior to undergoing Ketamine Therapy. Depending on the length of the patient’s clinical history and complexity, the evaluation will last one to two hours or longer. The initial consultation fee is $495. During the evaluation period, other treatment options and the appropriateness of Ketamine Therapy for that individual will be discussed. For those patients who are appropriate candidates and wish to proceed with Ketamine Therapy, the initial trial will consist of 3 treatments as noted above, within the first week. The additional cost for the 3 trial treatments is $800, for a total cost for evaluation and ketamine trial of $1295. Subsequent Ketamine treatments are $300 each.
Those patients who are currently in treatment with Dr. Boyadjis or who have been evaluated within the last year by Dr. Boyadjis, will NOT need to be fully reevaluated.
8. Will treatment be covered by insurance and/or Medicare?
At this time, Ketamine Therapy is NOT an FDA-approved treatment for Major Depressive Disorder, and thus insurance reimbursement is unlikely. However, as individual plans vary greatly, please contact your insurance company for more information about Ketamine Therapy for the treatment of depression.
9. Is Ketamine Therapy intended to replace antidepressant medications?
At this time, ketamine should not be considered a replacement for antidepressant medication. Ketamine is considered a most viable treatment option for those who have tried and failed medications and other treatment modalities. If you are currently taking an antidepressant and experiencing benefit, there is no need to discontinue its use during Ketamine Therapy.
10. What are the risks of Ketamine Therapy?
Intranasal ketamine for the treatment of depression has been remarkably well-tolerated in studies conducted thus far. Potential side effects include: weakness, fatigue, feeling “strange,” cardiac arrhythmias, an increase or decrease in heart rate, an increase or decrease in blood pressure, nausea, vomiting. Because this drug has psychogenic properties, the possibility exists for patients experiencing hallucinations.
11. What has ketamine been used for?
Ketamine is a short-acting anesthetic agent approved by the FDA in 1970. It is most commonly used in both human and veterinary medicine in minor surgical procedures as an anesthetic and analgesic. Typical methods of ketamine delivery include intravenously or be intramuscular injection, although it may also be used orally, rectally, or intranasally. Historically, ketamine has been important for use in emergency situations and on the battlefield as it maintains cardiac output and is less likely to suppress respiration.