Ketamine is receiving increasing attention as a promising treatment for depression. However, so far, few studies have analyzed its effectiveness in real-world clinical settings, especially in patients with complex mental disorders.
A new study based on data from veterans who had repeatedly tried to treat depression but remained with severe symptoms showed that a course of intravenous ketamine infusions helped many patients. In some cases, it was even possible to achieve complete remission.
Key results of the study
- Almost 50% of veterans who received intravenous ketamine infusions at U.S. Department of Veterans Affairs hospitals reported a significant reduction in depression symptoms after six weeks of treatment.
- In 25% of patients, the level of depression decreased by half.
- 15% of patients achieved complete remission after the course of infusions.
- Most veterans continued to receive maintenance infusions for several months.
Why are these results important?
The findings of this study may help to develop effective protocols for the use of ketamine for the treatment of depression in both military hospitals and civilian clinics. While ketamine has quickly gained attention as an innovative tool, there has been no large-scale research on its long-term effectiveness.
Although ketamine treatment is becoming more and more available in medical facilities for veterans, it is still limited. Usually, the treatment is prescribed by a psychiatrist in cases where standard methods (antidepressants, psychotherapy) do not work.
Dr. Paul Pfeiffer and Dr. Avinash Gosanagar, researchers from the University of Michigan Medical School and the Ann Arbor VA Healthcare System (VAHS), analyzed data from the U.S. Department of Veterans Affairs' national electronic health records system.
How does ketamine treatment work?
Patients received an average of 18 infusions over several months. Initially, treatment was administered twice a week, and then the intervals were gradually increased.
Despite the significant results, the researchers emphasize that ketamine is not a "magic pill." Only a small proportion of patients experience significant relief after the first infusion. However, for those who have been suffering from severe depression for a long time without positive dynamics from traditional methods, even a partial improvement is an important achievement.
Complex patient profile
In addition to depression, 70% of the study participants were diagnosed with post-traumatic stress disorder (PTSD), 50% with anxiety disorder, and 27% had problems with alcohol or substance use.
According to Dr. Gosanagar, chronic mental disorders cannot be completely cured with ketamine, but it does allow for faster improvement, which can give patients hope.
Most of the veterans who turned to ketamine therapy clinics had already tried dozens of other treatments. On average, they had taken six different antidepressants in their lifetime, and 20% had been hospitalized for mental health issues in the past year. Some have also tried electroconvulsive therapy (ECT) or rTMS, but without significant results.
What's next?
Ketamine was originally used as an anesthetic and still requires special controls due to the potential for abuse. In 2019, the U.S. Food and Drug Administration (FDA) approved esketamine nasal spray (a form of ketamine), which is used to maintain remission after intravenous treatment.
The WAAHS offers both intravenous ketamine and nasal esketamine to maintain the effect after treatment. However, clinics that provide both options are still rare.
To ensure safe treatment, patients with a history of alcohol or drug abuse must be in stable remission. Before each infusion, tests are performed to ensure the absence of psychoactive substances in the body.
The researchers plan to further analyze the new data to compare the effectiveness of different treatment protocols in different hospitals and identify factors that influence patients' refusal of therapy.
Experts from the Neuromodulation Program at the University of Michigan Medical Center are also continuing to explore the use of ketamine in conjunction with other treatments such as ECT and rTMS.
Conclusions.
Treatment with ketamine opens up new possibilities for patients with severe depression that is resistant to standard methods. However, it requires careful monitoring and an individualized approach.
As Dr. Pfeiffer emphasizes, we are only at the beginning of the journey to fully understand the effects of ketamine on mental health. The next decade could bring significant changes in the treatment of resistant depression and other complex mental disorders.
The Expio Medical Center has launched its own clinical trial of ketamine-assisted integrative psychotherapy in military personnel with treatment-resistant post-traumatic stress disorder (PTSD).
