Treatment of major depression with Ketamine

Major depression, or chronic depression, is a state of mind that is very difficult to get out of without professional help and good treatment.

What is Treatment-Resistant Major Depression?

Major depression is a medical condition characterized primarily by a state of sadness, feelings of emptiness or despondency, and a loss of interest in everyday activities. The development of major depression is variable in terms of the severity of symptoms, the recurrence of depressive episodes, and the duration of periods of symptomatic remission. However, to be considered major depression, symptoms must cause significant social and occupational impairment for a minimum of two weeks.

More than half of the people who suffer from depression do not remit the diagnosis after the first treatment and a third part also do not obtain it after going through multiple treatments. When a person does not respond adequately to two cycles of treatment with different drugs, they can develop what is known as treatment-resistant major depression.

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    What Treatments Are There For Treatment-Resistant Major Depression?

    The options considered in clinical practice to treat people with treatment-resistant major depression include increasing the dose of the usual medication, switching to a different drug, or combining pharmacotherapy with appropriate psychological treatment.

    People with highly resistant depression may choose techniques such as electroconvulsive therapy, repetitive transcranial magnetic stimulation, or deep magnetic stimulation. However, these procedures pose some logistical limitations that make long-term therapy and treatment of major depression difficult.

    For some years now, studies with ketamine have shown rapid and robust efficacy in the treatment of treatment-resistant major depression, considered the greatest pharmacological advance in the last 50 years. And making the treatment of major depression with ketamine, one of the most effective.

    Is Ketamine Safe To Treat Major Or Severe Depression?

    Ketamine has been used as an anesthetic in hospital practice for over 50 years, demonstrating a level of safety as few drugs have achieved. The fact that it does not alter the respiratory system, nor the ability to swallow and that it only produces a slight stimulation of the cardiovascular system, has made it frequently used in children with congenital heart diseases. However, its use is not recommended in people with severe hypertension problems.

    Despite its high safety, ketamine can evoke powerful psychoactive effects when administered at anesthetic doses, causing a transient state of altered consciousness. This is the main reason why it has not been used indiscriminately in hospital practice. However, the psychoactive effects are minimal at the doses commonly used in the treatment of resistant depression.

    However, since this change in consciousness may be attractive to some people, recreational use of ketamine has spread internationally over the last decade. This type of consumption has come to generate, in exceptional cases, patterns of daily abuse that have been interpreted as a response to dependence on this substance. However, there is no clear scientific evidence that ketamine produces a psychophysiological dependence, nor a withdrawal syndrome when withdrawn. In any case, the ketamine administration regimen used in the treatment of depression avoids any risk of abuse and dependence.  

    What are the differences between ketamine treatment and other antidepressant medications?

    There are three relevant differences between ketamine and classic antidepressants in the treatment of resistant depression.

    The most important difference is efficiency. Scientific evidence shows that in those who do not experience symptomatic relief after going through two different cycles of antidepressants, nearly half of these patients can improve significantly after a single ketamine administration. Making ketamine treatment one of the most effective for major or chronic depression.

    Another relevant difference is the speed with which ketamine exerts its antidepressant effect. While conventional drugs take between two and six weeks to take effect, a meta-analysis study has shown that 36% of 561 patients improved significantly before 24 hours, 41% after 24 hours and 48% between 2 and 7 days after a single ketamine infusion. This is a key factor especially in those who are at risk of suicide, since the rapidity to dilute suicidal thoughts can prevent fatal events.

    Finally, while antidepressant medications can cause side effects in some people, such as gastrointestinal problems or decreased sexual desire, taking ketamine does not produce side effects. Exceptionally, cases of ulcerative cystitis have been reported in recreational users who have abused this substance or who have consumed it daily for the relief of chronic pain. However, to date, there is no clinical case that has suffered this type of problem with the administration guidelines used in the treatment of resistant depression.

    What psychological effects can be felt during a ketamine infusion?

    Although the doses of ketamine used in the treatment of depression are very low, some people may experience sensations that they have not felt before. The most common sensations can be: dizziness, distortions in the sensation of the body itself (such as a slight sensation of buoyancy) or distortions in the visual perception of external stimuli. Other people can connect with significant aspects of their therapeutic process. Although the intensity of these sensations is usually relatively low, they can be experienced positively or negatively depending on each person.

    However, the psychological material that could emerge during the acute effects may be relevant from a psychotherapeutic aspect. For this reason, it is not considered that these psychological effects should be avoided, if not the opposite. In order to promote a state of introspection that favors connection with the therapeutic process, the patient will lie down in a comfortable chair, being able to use a mask and headphones through which they can listen to quiet music chosen especially for this purpose. .

    The patient will remain monitored and under medical observation during the 40 minutes that the ketamine administration lasts, in order to interrupt the treatment if the patient wishes. A subsequent rest period may be necessary until the person is in perfect condition to leave the clinic. The estimated time to carry out the complete treatment does not usually exceed an hour and a half, always being an outpatient regimen.

    How long do the antidepressant effects of ketamine last?

    In most patients, ketamine produces a rapid and robust antidepressant response, albeit transient. However, the duration of antidepressant effects varies greatly depending on each person. Clinical studies show that antidepressant effects can be maintained between one week and three months after administration of a single infusion. However, it is also known that the antidepressant effect of ketamine is cumulative, so it is recommended to follow a regimen of repeated doses. In this way, the antidepressant effects have been maintained for more than 15 months after the last infusion.

    However, the prolongation of antidepressant effects could also depend on the role that the patient takes with respect to their therapeutic process. Ketamine can facilitate the learning of cognitive and behavioral techniques focused on the regulation of symptoms, which is why psychotherapeutic monitoring is especially recommended during the period of drug administration. In this way, the pharmacological intervention together with the psychotherapeutic, can have a catalytic effect that maximizes and prolongs the benefits of the treatment.

    What is ketamine therapy for Major Depression?

    The ketamine administration regimen agreed by the scientific community consists of two or three infusions over two or three weeks (a total of six infusions). Following this guideline, safety, tolerability, and freedom from dependence have been widely demonstrated.

    Although we still do not know the exact mechanism by which ketamine produces its antidepressant effects, it is considered that the activation of certain brain proteins (such as BDNF and mTOR) could enhance neuroplasticity. This indicates that ketamine would be opening a temporary window in which patients could experience

    greater psychological flexibility. This new state of mind can facilitate commitment to a psychotherapeutic intervention and learning new strategies to regulate your mood. Therefore, it is highly recommended that patients engage in psychotherapeutic treatment during drug treatment, either with their regular psychotherapist or with the intervention model that they consider most appropriate.

    The components of the treatment that we consider relevant when promoting the comprehensive recovery of the patient from a neurological, psychological and social approach are described below. 

    • Intravenous administration of six ketamine infusions (two infusions per week over three weeks). Those who live outside of Barcelona can have access to a maximum of five infusions in a week, in order to avoid the logistical complications that travel entails.
    • Individual psychotherapeutic accompaniment based on the acceptance and commitment model and focused on the development of self-compassion. This model emphasizes the creation of a sustainable change in the behavior patterns of the patient, offering a novel therapeutic approach that is showing promising empirical results. This type of accompaniment consists of six weekly sessions of 50 minutes that can be carried out virtually or in person.
    • Group sessions of mindfulness based on cognitive therapy (MBTC). These sessions have been specially designed to reduce the relapse rate in people who suffer recurrent episodes of depression, being considered the most effective psychotherapeutic treatment to date. In addition, these types of sessions facilitate community support among peers. The mindfulness program consists of eight weekly sessions of two and a half hours that can be carried out virtually or in person.

    Patients will be able to access any of the components of this treatment according to their disposition and their needs.

    What steps should I take to access this type of treatment for major depression?

    Given the critical situation left by the Covid-19 pandemic, the BeckleyMed Foundation and CITA have joined forces to provide this treatment to people who are suffering from treatment-resistant depression and have not found an alternative to help them restore their well-being. . We are currently taking the appropriate steps to offer this treatment as soon as possible. However, given the interest and demand to access this type of treatment, we have opened a period of evaluation and detailed information that will facilitate attending patients in order of request.

    If you are interested in accessing this treatment, you can call by phone or leave your contact information in the following link. You will then be given an appointment to hold a clinical session by video-conference. During this session, a diagnostic interview will be carried out and all doubts that may be clarified will be clarified.

    arise with respect to the treatment process. After this clinical session, you will be able to find out if it is a potentially effective treatment for you and, if so, you will be given priority to access it in relation to patients who arrive later.

    Please keep in mind that under no circumstances should you stop taking your usual medication during this process.