I dream of ketamine

I love Canada, but sometimes we’re a little behind.  Drugs are slower to get approved by Health Canada compared to the US, and we have fewer clinical trials going on here.  I would be really interested in trying out ketamine, but it doesn’t have Health Canada approval for use in depression, there are no clinical trials in my neck of the woods accepting new patients, and going to a private clinic in the US would be extremely expensive.  So for now, all I can do is dream of ketamine.  But in the meantime, what is ketamine and how does it work?

Ketamine has been in use for some time as an anaesthetic drug, and it has been abused as the club drug Special K.  In the last several years multiple research trials have shown that it has a rapid onset antidepressant effect (within about 24 hours).  It increases rates of remission in major disorder, but the effect is not as pronounced for bipolar depression.  It appears to have a protective effect against suicide, and unlike many antidepressants it doesn’t appear to trigger mania.

Mechanism of action

It has a different mechanism of action than other antidepressant medications.  It acts on NMDA and AMPA receptors, affecting the balance between the calming neurotransmitter GABA and the excitatory/stress neurotransmitter glutamate.  It also boosts production of BDNF (brain-derived neurotropic factor), which in turn promotes the formation of new synaptic connections in the brain.  It has been suggested that people with depression may have abnormalities related to their NMDA receptors and experience what’s referred to “excitotoxicity” from glutamate overactivity.

Dosing

Ketamine is typically given at a dose of 0.4-0.5 mg per kg of body weight, which is a lower dose than would be used for anaesthesia, with 1-2 doses per week.  The effect from each dose typically lasts 3-7 days, but can last up to 15 days.  It can be given as an intravenous infusion, or the esketamine version of the drug is available as a nasal spray.

Side effects

Apparently side effects are generally mild and wear off within 2 hours.  While harmful effects to the bladder can occur at high doses, this hasn’t been demonstrated at the doses used for depression treatment.  It can have dissociative effects while the drug is being infused and in that 2 hours window after the dose, which could potentially limit the tolerability for some people.  It can trigger spikes in heart rate and blood pressure, as well as headaches, dizziness, blurred vision, drowsiness, abnormal sensations, and perceptual disturbances.  Patients remain in the clinic for a period of time following the dose so that they can be monitored.

What are your thoughts?  Have you had any experience with ketamine?

 

You can find out more about ketamine and other medications in my book Psych Meds Made Simple: How & Why They Do What They Do, available on Amazon.

 

25 thoughts on “I dream of ketamine

  1. kbr0632 says:

    Wow..sounds like a great drug. But I don’t like the side effects. However, when I am in a serious depression…as I know others can tend to fall into..maybe the pros could outweigh the cons. If only those side effects were not part of the dosage (the rapid heart rate, dissociative). If only a drug like this could work…without those serious risks. Looks like we are making progress I guess with meds like this. But not sure I am willing to take that risk right now.

    Liked by 1 person

  2. Alexis Rose says:

    I think its interesting how there is research being done with certain drugs and how they help with different mental illness. I know there are some trials with good success going on right now with MDMA and PTSD. Heres hoping for more options!

    Liked by 2 people

  3. Secrets of Supressed Trauma says:

    I’ve used Ketamine recreationally and I can tell you being someone diagnosed with bipolar depression the whole time I felt like I was falling. I was falling in what they call a, “K hole” its as if you’re falling down a rabbit hole and never going to hit a bottom, well until it wears off.

    Liked by 1 person

  4. soberonketamine says:

    I tried it and definitely had a positive result–though as a sober AA member, I’ve always liked all kinds of drugs. This one makes me feel awfully conflicted (which is why I set up a blog, hoping to meet other sober folks who’ve used ket for PTSD…..

    Liked by 1 person

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