Ketamine vs Traditional Medications

Ketamine is one medication out of many used to treat mood disorders. How does it compare to traditional medications?

In the realm of mental health treatment, the search for effective and fast-acting antidepressants has been a constant pursuit. Traditional antidepressants have long been the go-to option for managing depression and related mood disorders. However, the emergence of ketamine as a potential game-changer has sparked interest and debate among healthcare professionals. This blog will compare the benefits and drawbacks of ketamine with those of traditional antidepressants.

Traditional Antidepressants

Traditional antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), have been the standard treatment for depression for decades. These medications work by regulating neurotransmitters in the brain, mainly serotonin and norepinephrine, to improve mood and alleviate depressive symptoms.

Benefits

• Proven Track Record: Traditional antidepressants have been extensively studied and clinically tested, showing effectiveness in a large number of patients over time although the overall efficacy has been brought into question by deeper examination of unpublished studies and more recent analysis.
• Wide Availability: They are widely available, relatively affordable, and covered by insurance plans in many cases.
• Long-term Use: Traditional antidepressants are suitable for long-term treatment, helping patients manage chronic depressive disorders.

Drawbacks

• Delayed Onset: It often takes several weeks to notice any significant improvement in mood. This can be frustrating and discouraging for patients in immediate distress.
• Side Effects: Common side effects include nausea, weight gain, sexual dysfunction, and sleep disturbances. For some the side effects are so concerning that more medications are needed to blunt the side effects leading to a complicated medication regimen.
• Treatment Resistance: A considerable portion of patients may not respond to traditional antidepressants, leading to the need for alternative treatments.

Ketamine: A Novel Approach

Ketamine, originally known as an anesthetic and a recreational drug, has emerged as a novel and intriguing treatment for depression. In recent years, it has gained popularity due to its rapid antidepressant effects, particularly in treatment-resistant depression cases. The key to ketamine’s antidepressant effect lies in its interaction with the NMDA (N-methyl-D-aspartate) receptors in the brain. NMDA receptors play a crucial role in synaptic plasticity, memory formation, and learning.

However, in cases of depression, these receptors may become dysregulated, contributing to the disorder’s symptoms. Ketamine acts as an NMDA receptor antagonist, temporarily blocking these receptors. This action leads to a cascade of molecular events that ultimately increase the release of a neurotransmitter called glutamate. This increased glutamate release triggers a series of neuroplasticity mechanisms. This enhances synaptic connectivity and promoting the formation of new neural connections. Ketamine’s ability to stimulate neuroplasticity processes like neurogenesis (the generation of new neurons) and synaptogenesis (the formation of new synapses) contributes to its efficacy as an antidepressant. These mechanisms help repair damaged neural circuits and create new pathways, offering a potential explanation for its long-lasting benefits.

Benefits

• Rapid Action: Ketamine’s most significant advantage is its rapid onset of action. Many patients experience significant improvements in mood within hours to a few days after administration.
• Treatment-Resistant Depression: Ketamine has shown remarkable efficacy in patients who did not respond to traditional antidepressants. It offers hope for those with persistent depressive symptoms.
• Low Dependency: When administered under controlled medical settings, ketamine has shown a low risk of developing addiction or dependency. In the context of an infusion clinic, ketamine is initially administered at most three times per week. As treatment progresses the infusions are spaced out from weeks to months apart. This intermittent use also protects against the formation of dependency.
• Side effects: The side effects from ketamine infusions appear to be limited to the time of the actual infusion. But there have not been proper long-term studies in the context of using ketamine to treat mood disorders.

Drawbacks

• Short-term Effects: Ketamine’s antidepressant effects can be short-lived, requiring repeated treatments or a maintenance schedule. The maintenance schedule can be variable, but most patients will require infusions every 3-8 weeks.
• Expensive: Compared to traditional antidepressants, ketamine treatments can be cost-prohibitive for some patients, particularly when not covered by insurance. We hope that this will change in the near future. There is increasing evidence of the efficacy of ketamine for treatment-resistant cases. But the insurance industry is a complex machine that is far from perfect.
• Safety Concerns: The long-term effects of ketamine use for depression are still under investigation. More research is needed to fully understand its safety profile. It is fair to point out that ketamine has been used as an anesthetic safely since the 1960’s. Many patients have received repeated doses without reports of long-term effects. It is likely that the same rule will apply using smaller doses that are slowly infused during ketamine therapy

Conclusion

Traditional antidepressants have been the cornerstone of depression treatment for years, effectively helping millions of people around the world. However, ketamine’s rapid onset of action and effectiveness in treatment-resistant cases have opened new possibilities in the realm of mental health treatment. Traditional antidepressants remain the first-line treatment for many individuals. Ketamine offers hope for those who have struggled to find relief through traditional means. Research continues and the understanding of ketamine’s long-term effects continues to improve. As a result, ketamine may become a more accessible and widely used option for individuals facing treatment-resistant conditions.

Ultimately, a person choosing initiate ketamine treatment should consult with a qualified healthcare professional. One should take into account the individual’s unique needs, medical history, and preferences. For some, a combination of ketamine therapy with traditional antidepressants will be the best way forward. For others, ketamine will allow for the gradual transition away from other antidepressant medications. These medications may provide inferior relief or come with undesirable side effects. As our understanding of depression and its treatments evolves, the mental health community continues to strive for better and more effective solutions. Solutions aimed at improving the lives of those affected by this challenging condition.  

NW Ketamine Infusion

July 20, 2023

Disclaimer: This blog does not constitute medical advice but rather a synthesis of published reports and accumulation of personal experience in treating patients using ketamine. The information in this post should not be used to guide medical decisions.