Treatment resistant depression

Statistics suggest that 1 in 15 Americans will suffer from severe depressive episodes each year; 1 in 6 over a lifetime.

It is estimated that about 1/3 of people struggling with clinical depression are “treatment resistant,” meaning that multiple medications and treatments have been tried without adequate improvement of depression symptoms.

Ketamine is not a first line treatment. Patients need to verify that they have tried other treatments that have been unsuccessful to pursue ketamine treatment in most instances.

What is Ketamine

Ketamine is primarily an anesthetic drug that has also been used recreationally, and in the recreational context is sometimes called Special K. Ketamine works quickly, sometimes within hours.

Response rates are reported being as high as 70% (and higher) with injectable Ketamine being provided at clinics.  How long the improvement lasts is variable. Long term effects of Ketamine for depression treatment have not been thoroughly studied.

The FDA has fast tracked Ketamine, but it is currently being used as a depression treatment off-label. It is not covered by most insurances, although Kaiser Permanente is breaking trail in that area. Two newer versions of the drug, esketamine (Spravato), a ketamine nasal spray,  and rapastinel, a rapid acting antidepressant are also being fast tracked. 

All forms of the drug are to be administered in a clinic setting and will require the presence of medical personnel and monitoring of the patient for at least 2 hours. It is likely it will only be prescribed by psychiatrists for depression treatment and not be available directly to patients outside of a clinic setting. Most patients receiving injections will experience 20-40 minutes of dissociative/psychedelic states during that two hour period.

Where can I get it and how much does it cost

Ketamine is also being offered as a treatment for ptsd, pain, anxiety, and other issues, depending on the clinic or provider. In this post I am focusing on using Ketamine to treat depression.

Ketamine is being offered in clinics across the country in injectable form currently. 

The cost per injection is estimated to be about $400-$800. Treatment may begin with 6 infusions over 2-4 weeks, followed up by monthly maintenance doses. Many potential patients do not have the resources to pay for the treatments and as an alternative may choose to apply to participate in clinical trials.

Clinics can vary widely in their medical personnel and may include anesthesiologists, nurse practitioners, psychiatrists, pain physicians.

Screening processes are variable. Collaboration with primary care doctors and mental health providers can be variable. Follow up can be variable. 

Screen your provider

Some things to consider (much like you would for any medical treatment):

How long has the clinic been in business specifically treating depression with Ketamine?

Is the clinic set up for any medical complications should they occur?

Who will administer and monitor the injections? 

Will someone be present during the monitoring period and will they be trained to facilitate the period of dissociative/psychedelic state with the patient? Reports suggest that many patients find this an insightful and meaningful part of the process. 

How was the dosing protocol determined, eg, number of doses per week for how many weeks. It has been suggested that one of Ketamine’s effects is promoting neuro-plasticity and repair and that effect should be considered in the dosing protocols. 

What is generally the maintenance protocol?

Does the clinic consult and collaborate with your other providers, eg, primary care doctor, psychiatrist, psychotherapist?

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