Is Ketamine Safe as a Depression Treatment?
In 2019, for the first time in decades, the Food and Drug Administration (FDA) approved a new type of drug for the treatment of major depressive disorder. The medication is an esketamine nasal spray that is derived from ketamine, a psychedelic drug that appears to have antidepressant properties and to be helpful for people with treatment-resistant depression. Only one-third of people with depression get complete relief from treatment with antidepressants, according to a 2014 study.
Despite the FDA approval, ketamine still raises questions and cause for concern. How safe is it?
Psychiatry Goes Psychedelic
The current trend in treating psychiatric illnesses is to go beyond traditional pharmaceutical medications by using psychedelic drugs, especially ketamine, but also LSD, psilocybin mushrooms, ecstasy, ayahuasca, and ibogaine.
First developed in the 1960s, ketamine was administered as an anesthetic and given to soldiers during the Vietnam War. Due to its hallucinogenic effects, ketamine has a reputation as a popular and illicit party drug, going by the nickname “Special K.” It dulls pain and users often feel detached or dissociated from their own body.
In 2000, researchers started studying ketamine as a treatment for depression and discovered that it improves mood much faster than traditional antidepressant medications, and sometimes works when other drugs have failed.
Ketamine Shows Potential
More than 100 studies have shown that ketamine has antidepressant effects. For example:
- In 2013, the American Journal of Psychiatry showed that ketamine produced rapid antidepressant effects in severe and chronic depression.
- A 2017 review in Mental Health Clinician found that people taking ketamine experienced significant improvement in their symptoms of depression compared with those taking a placebo. The drug also quickly reduced symptoms in people struggling with treatment-resistant depression.
Ketamine in the Brain
Unlike antidepressants, which work by enhancing neurotransmitters like serotonin and dopamine, ketamine is thought to change the way brain cells talk to each other—similar to a computer reboot or hardware fix. Basically, ketamine binds to receptors in the brain that trigger the production of glutamate, an excitatory neurotransmitter that influences how neurons communicate. It is believed that this process has an impact on thinking patterns, moods, and more.
Although ketamine offers some promise, it is not a solo cure-all. Expecting a pill or nasal spray to provide a complete solution to depression is wishful thinking. To fully address any mental health condition, a comprehensive plan that factors in all the biological, psychological, social, and spiritual aspects of a person’s life is critical to any treatment plan.
The Downside of Ketamine
Ketamine is known to cause side effects, such as dissociation (out-of-body experiences), perceptual disturbances (feeling like time has slowed down, for example), high blood pressure, dizziness, and nausea. In addition, some research has found the drug may be addictive.
A 2018 study in the American Journal of Psychiatry argues for caution. It showed that the antidepressant effects of ketamine were eliminated with the opiate blocker naltrexone, meaning it worked by activating the opiate centers of the brain.
A review in Neurobiology of Stress that same year concluded that “both preclinical and clinical studies indicate that repeated treatment with low-dose ketamine infusions can have addictive properties and induce cognitive deficits.”
And it remains unclear what happens when a person stops taking the drug.
In the long run, could it have similar damaging effects as other drugs of abuse and be causing more harm than good? Brain SPECT imaging has shown that opioids, benzodiazepines, and other drugs of abuse cause alterations in blood flow and activity in the brain that impair its function. More research on ketamine is needed to understand its long-term effects on the brain and to ensure its long-term safety.
At Amen Clinics, we use brain SPECT imaging, which can reveal exposure toxins that are hurting the brain and impacting its function. Our brain imaging work has shown that some medications—such as benzodiazepines often prescribed for anxiety, as well as chemotherapy— have a harmful effect on the brain. We have helped many people overcome treatment-resistant depression using the least toxic, most effective therapies.
To learn more or to schedule your comprehensive evaluation, please visit us online or call 888-288-9834.