Ketamine is gaining increasing attention as a promising treatment for depression. However, few studies have examined its effectiveness in real-world clinical settings, especially in patients with complex psychiatric disorders.
A new study of veterans who had tried multiple treatments for depression but remained severely depressed found that a course of intravenous ketamine helped many patients, and in some cases, even achieved complete remission.
Key research findings
- Nearly 50% of veterans who received intravenous ketamine infusions at U.S. Department of Veterans Affairs hospitals reported a significant reduction in depressive symptoms after six weeks of treatment.
- In 25% of patients, depression levels were halved.
- 15% of patients achieved complete remission after a course of infusions.
- Most veterans continued to receive maintenance infusions for several months.
Why are these results important?
The findings from this study could help develop effective protocols for using ketamine to treat depression in both military hospitals and civilian clinics. While ketamine has quickly gained attention as an innovative treatment, there has been no large-scale study of its long-term effectiveness.
Although ketamine treatment is becoming increasingly available in veterans' health care settings, it is still limited. It is usually prescribed by a psychiatrist when standard treatments (antidepressants, psychotherapy) have failed.
Dr. Paul Pfeiffer and Dr. Avinash Gosanagar, researchers from the University of Michigan Medical School and the Ann Arbor VA Veterans Affairs Health System (VAAHS), analyzed data from the U.S. Department of Veterans Affairs' national electronic health record system.
How does ketamine treatment work?
Patients received an average of 18 infusions over several months, initially twice weekly, with the intervals gradually increasing.
Despite the impressive results, researchers emphasize that ketamine is not a “magic pill.” Only a small percentage of patients experience significant relief after the first infusion. However, for those who have suffered from severe depression for a long time without positive dynamics from traditional methods, even partial improvement is an important achievement.
Complex patient profile
In addition to depression, 70% of study participants were diagnosed with post-traumatic stress disorder (PTSD), 50% had an anxiety disorder, and 27% had problems with alcohol or substance use.
As Dr. Gosanagar notes, chronic mental disorders cannot be completely cured with ketamine, but it allows for faster improvement, which can give patients hope.
Most veterans who come to ketamine clinics have already tried dozens of other treatments. On average, they have taken six different antidepressants in their lifetime, and 20% have been hospitalized for mental health issues in the past year. Some have also tried electroconvulsive therapy (ECT) or transcranial magnetic stimulation (rTMS), but without significant results.
What's next?
Ketamine was originally used as an anesthetic and still requires special monitoring due to the potential for abuse. In 2019, the U.S. Food and Drug Administration (FDA) approved esketamine nasal spray (a form of ketamine) for use in maintaining remission after intravenous treatment.
The VAAAHS offers both intravenous ketamine and nasal esketamine for post-treatment maintenance, but clinics that offer both options are still rare.
To ensure safe treatment, patients with a history of alcohol or drug abuse must be in stable remission. Tests for the absence of psychoactive substances in the body are performed before each infusion.
The researchers plan to further analyze the new data to compare the effectiveness of different treatment protocols across hospitals and identify factors that influence patients' refusal of therapy.
Specialists in the Neuromodulation Program at the University of Michigan Medical Center also continue to study the use of ketamine in conjunction with other treatments, such as ECT and rTMS.
Conclusions
Ketamine treatment offers new possibilities for patients with severe, treatment-resistant depression. However, it requires careful monitoring and an individualized approach.
As Dr. Pfeiffer emphasizes, we are only at the beginning of the journey to fully understanding 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.
Expio Medical Center has begun its own clinical trial of ketamine-assisted integrative psychotherapy in military personnel with treatment-resistant post-traumatic stress disorder (PTSD).
