Doctors are wrestling with the ethical and legal challenges of prescribing ketamine for severely depressed or suicidal patients. The drug may help some people, but doctors worry about the possibility ketamine could be abused or cause side effects (BMC Medical Ethics, Jan. 14, 2016).
That said, severe depression is a life-threatening condition. Suicidal thoughts are a common consequence, especially since there are no quick fixes for this kind of depression. Most approved antidepressant medications take several weeks to start working.
That’s why there is such interest in the fast-acting anesthetic ketamine. An article in Molecular Psychiatry (Jan. 19, 2016) notes that ketamine “elicits antidepressant actions in hours” and that this rapid effect has been transformative.
This reader tells a fascinating story:
Q. I received a ketamine infusion several months ago and it literally saved my life. My 30+ year depression was severe (unable to feel, no relationships, unable to work, extreme anxiety and fatigue, etc). I volunteered for a study at the National Institutes of Health for patients with extreme, treatment-resistant depression, where I was given ketamine.
The effect was instantaneous and miraculous. All symptoms were completely relieved within two hours. The relief lasted about two weeks. Most of my fellow patients at NIH experienced the same. There are many doctors now using ketamine in clinical practice for severe depression. I had no trouble finding one and have since been treated with ketamine for several months.
You cannot imagine the sensation of decades of suffering draining away rapidly. For the first time in my life (age 50) I am finally able to get out of bed in the morning, experience joy, socialize, work, date, etc. Ketamine doesn’t work for every patient, but the response rate is astonishingly high (65-80%). If you are reading this post while suffering long-term, extreme depression: please consider volunteering for a ketamine study or find yourself a doctor who employs it in their practice.
A. Your experience has been confirmed by a surprising number of small studies. One published in the journal Psychological Medicine (online, Aug, 2015) reports on a randomized, controlled trial of ketamine in 24 suicidal patients. Half were given ketamine and the other half received a different anesthetic called midazolam (as a placebo). Within two days the people who received ketamine had a significant reduction in suicidal thoughts compared to midazolam. The researchers concluded:
“The current findings provide initial support for the safety and tolerability of ketamine as an intervention for SI [suicidal ideation] in patients who are at elevated risk for suicidal behavior. Larger, well-powered studies are warranted.”
Research published in the Journal of Psychopharmacology (online, April 3, 2014) from the UK demonstrated that infusions of ketamine produced dramatic responses in severely depressed patients. Like you, some of these individuals had been suffering for decades.
Fast Antidepressant Action:
Unlilke traditional antidepressants, which can take weeks to kick in, ketamine sometimes produces noticeable results within a few hours. The lead investigator, Dr. Rupert McShane, reported to the BBC that “It really is dramatic for some people; it’s the sort of thing really that makes it worth doing psychiatry; it’s a really wonderful thing to see.”
Although some of the patients had long-lasting benefit, others relapsed. But keep in mind that ketamine is not given daily like typical antidpressants. This study involved three to six infusions over a period of three weeks.
Another study conducted by scientists at the National Institute of Mental Health (Journal of Psychiatric Research, Nov. 2014) found that: “Ketamine infusion was associated with significant reductions in suicidal ideation compared to placebo, when controlling for the effects of ketamine on depression and anxiety.”
The History of Ketamine:
Ketamine was originally approved for human use as an injectable general anesthetic in 1970. It is especially helpful when severe pain is involved, such as in burn patients or during emergency surgery. That’s because it is both an anesthetic and an analgesic, meaning that it provides significant pain relief while helping the patient remain unconscious. Because it opens airways, it is especially helpful for asthmatics or patients with COPD (chronic obstructive airway disease). Ketamine is also used by verterinarians for a wide variety of animal surgeries.
Street Names for Ketamine
Caution about ketamine results in part because of its negative reputation as a club drug. The main street name for ketamine is Special K. Other names include “K,” “Cat Valium,” “Kit Kat,” “Super C” and “Green.”
When taken orally, the drug produces a “dissociative” effect that some describe as a detached or distorted sense of reality. It is a shame that ketamine has been abused, since its antidepressant potential is so exciting. This may have delayed research into this promising treatment.
Some investigators are studying the possibility of administering ketamine in a nasal spray (Intranasal Drug Delivery on INDD). A review in the Journal of Clinical Psychiatry (May, 2015) discusses this possibility.
To learn more about ketamine in the treatment of severe depression, here is a link to an earlier post, “Old Drug Has New Tricks Against Depression.”
Should you want to learn more about ketamine research in treating suicide, here is another helpful link.
Let us know your experience with depression. If you have participated in a ketamine trial, we would love to hear your story. You may also find our Guide to Dealing with Depression of value.
Revised January 21, 2015