Treatment-Resistant Depression (TRD) is among the most common and serious psychological diseases in the world today. In America alone, an estimated 2.8 million people suffer from clinical depression so severe that it defies treatment, leaving them in misery with few options.
However, in recent years new hope has come from an unexpected source: Ketamine. Originally formulated as an anesthetic drug for surgeries, and later adopted illegally as a party drug, Ketamine is now being seriously investigated for its potential ability to treat TRD when other anti-depressive medications fail.
If you suffer from clinical depression, should you consider Ketamine? Here's what you need to know.
Ketamine for Depression: The Facts
Ketamine was originally formulated in 1962 by researchers seeking better surgical anesthetics, with fewer hallucinatory side-effects. It was a success in this field, being used extensively in the Vietnam War and beyond. It is now considered an "essential medicine" by the World Health Organization.
More recently, groups began investigating it as a potential treatment for depression, following anecdotal reports of it lifting depressive symptoms in users. Unlike many other psychedelic substances, ketamine is a "dissociative" drug, where the user feels detached from their own body. Following the dose, the user typically also feels euphoria and an uplift in mood which can last for days or weeks.
Ketamine works by inhibiting the N-methyl-D-aspartate (NMDA) receptor in the brain, which regulates mood and pain perception. By shutting it down, the user is quickly 'cut off' from the feelings leading to depression.
This dissociative quality has proven effective in clinical trial for treating depression. In 2019, a nasal spray called esketamine (Spravato) was officially approved by the FDA for depression treatment, and its use in that capacity has expanded significantly since.
When used under clinical supervision, small doses of ketamine are considered generally safe, with few significant side effects in most people.
Who Is Prescribed Ketamine for Depression?
Currently, ketamine-based medications are only FDA-approved for use in patients with diagnosed Treatment-Resistant Depression. This means they have already tried at least two other anti-depressive medications, with little or no effect.
Ketamine therapy should only be done under direct clinical supervision. Properly administered, the patient is observed throughout their 'trip' by psychological experts, coupled with counseling and recovery assistance afterwards. A typical treatment regimen involves several treatments, each a couple weeks apart.
Taking any form of ketamine alone can be dangerous, as the user may behave erratically during the 'trip.' If you are considering ketamine for depression, be sure to obtain it legally via psychological clinics.
Are There Any Alternatives to Ketamine?
The idea of using psychedelic drugs for treating depression is not new. Many such drugs, such as MDMA and psilocybin, have been investigated for their clinical properties. Here's a quick rundown of the research, and how those alternatives compare to ketamine.
Ketamine vs MDMA ("Ecstacy")
MDMA works in a different way than ketamine, affecting the serotonin and adrenergic receptors in the brain. In short, it stimulates "feel good" chemicals in the brain, while reducing the user's tendency to feel fear. MDMA is noted for its qualities as an empathogen, increasing empathy for other living things and a feeling of connection with them.
On the other hand, MDMA tends to have more severe side-effects. Used improperly, it can cause the user to experience serious hallucinations, or even become a danger to themselves.
MDMA has also been undergoing clinical investigation for depression treatment, with positive results. It has been designated a "breakthrough therapy" by the FDA and fast-tracked for additional testing. It seems particularly promising for treating post-traumatic stress disorder (PTSD).
However, as of writing in 2024, no form of MDMA has been approved for clinical use. Currently, all usage of MDMA - even under psychiatric supervision - is illegal unless done specifically as part of an approved scientific trial.
Ketamine vs Psilocybin ("Magic Mushrooms")
Psilocybin is a hallucinogenic substance obtained from various species of naturally-growing mushrooms. It is classified as a tryptamine psychedelic, noted primarily for causing hallucinations. Similarly to MDMA, it works by affecting serotonin production.
Researchers have noted the similarities in the drugs' method of action, and a handful of studies have tested psilocybin as a potential depression treatment. The results of these were promising, suggesting psilocybin may have similar long-lasting anti-depression effects to ketamine, while having fewer side effects than MDMA.
Currently, psilocybin is illegal in all forms, and unlike MDMA, has not received any special recognition by the FDA. Its potential to become an approved anti-depression drug is still unclear.
Is Ketamine an Option for Your Depression?
If you suffer from long-term depression which has resisted other treatments, ketamine is a promising option potentially worth exploring. However, this should only be done under the supervision of psychiatric experts, in a clinical setting. Never attempt to self-medicate with ketamine or any other psychedelic.
For those with depression, the most important thing is to seek help. Ask your doctor if ketamine treatment might be right for you.
