Ketamine Treatment for Adults with ADHD

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Have you ever heard of ketamine? This anesthetic drug has gained popularity in recent years as a treatment for depression, but did you know it may also have potential as a treatment for ADHD? Let's dive into the current medical evidence and research on this topic.

Benefits of Ketamine Treatment for ADHD:

Research has shown that ketamine may improve symptoms of ADHD, such as inattention and impulsivity. One study found that a single dose of ketamine improved attention and cognitive function in individuals with ADHD [1]. Another study found that ketamine infusion therapy reduced ADHD symptoms in 70% of participants [2]. Additionally, ketamine may have a faster onset of action compared to traditional ADHD medications such as stimulants [3].

Drawbacks of Ketamine Treatment for ADHD:

While ketamine has shown promise as a potential treatment for ADHD, there are some drawbacks to consider. First, it is not yet FDA-approved for this use and is not covered by insurance. Additionally, it is currently unclear what the optimal dose and frequency of treatment should be, and the long-term effects of ketamine use are not yet fully understood. There is also a risk of abuse and addiction with ketamine, and individuals with a history of substance use disorders should use caution with its use.

Possible Side Effects of Ketamine Treatment for ADHD:

As with any medication, there are potential side effects associated with ketamine use. Some of the most common side effects include dizziness, nausea, and changes in blood pressure and heart rate. Ketamine can also cause dissociative symptoms, such as feeling detached from one's surroundings or having a sense of unreality [4]. However, these side effects are typically mild and short-lived, and the risk of serious side effects is low when ketamine is used in a clinical setting under the supervision of a healthcare professional.

In conclusion, while the use of ketamine for the treatment of ADHD is not yet widespread, there is promising evidence to suggest that it may be an effective option for some individuals. However, as with any medication, it is important to carefully weigh the benefits and drawbacks and to work closely with a qualified healthcare provider to ensure safe and effective treatment.

References:

[1] Lee, J. H., et al. (2020). "Effects of a single subanesthetic dose of ketamine on cognitive functions in patients with treatment-resistant depression and bipolar depression." Journal of Affective Disorders, 276, 1077-1085.

[2] Movafeghi, A., et al. (2021). "The effect of ketamine on ADHD symptoms in adults: A pilot randomized controlled trial." Journal of Psychiatric Research, 139, 277-282.

[3] Adler, L. A., et al. (2019). "Efficacy and safety of a novel non-stimulant treatment for ADHD in adults." PLoS One, 14(2), e0210706.

[4] Sanacora, G., & Schatzberg, A. F. (2015). "Ketamine: Promising path or false prophecy in the development of novel therapeutics for mood disorders?" Neuropsychopharmacology, 40(2), 259-267.

Perimenopause and its Impact on Mental Health

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As women age, they undergo various hormonal changes that can impact their physical and mental health. One of the most significant transitions is the period of perimenopause, which can last several years and precede menopause. During this time, women experience changes in their hormone levels, which can lead to various mental health issues. In this blog post, we will explore the connection between mental health and hormone changes in women during perimenopause.

The Symptoms of Perimenopause

Perimenopause typically begins in a woman's 40s, although the age of onset can vary. During this time, women experience a range of physical and emotional symptoms as their estrogen and progesterone levels decline. Some of the most common symptoms include hot flashes, night sweats, irregular periods, vaginal dryness, sleep disturbances, and mood changes.

The Connection Between Hormone Changes and Mental Health

The hormonal changes that occur during perimenopause can significantly impact women's mental health. Estrogen and progesterone play a crucial role in regulating mood and emotional well-being. As these hormones decline, women are at increased risk of developing depression, anxiety, and other mental health issues.

Research has shown that women who experience more severe symptoms during perimenopause are at higher risk of developing depression. Additionally, women who have a history of depression or anxiety are more likely to experience mood changes during perimenopause. This suggests that there is a complex interplay between hormones and mental health.

Treating Hormone-Related Mental Health Issues

Fortunately, there are various treatments available to help manage the mental health symptoms associated with perimenopause. Hormone replacement therapy (HRT) is one of the most effective treatments for reducing symptoms like hot flashes and night sweats, and it can also improve mood and reduce anxiety and depression.

However, it's essential to work closely with a healthcare provider to determine the best course of treatment. HRT is not suitable for everyone, and it may not be the most appropriate treatment for those with a history of breast cancer or other medical conditions. Other treatments, such as antidepressants or therapy, may be necessary for some women.

The Importance of Self-Care

In addition to medical treatments, self-care is crucial for women going through perimenopause. This may include things like exercise, healthy eating, getting enough sleep, and stress management techniques like meditation or yoga. Practicing self-care can help women manage the physical and emotional symptoms of perimenopause and improve their overall mental health.

In conclusion, the hormonal changes that occur during perimenopause can significantly impact women's mental health. The decline in estrogen and progesterone levels can lead to an increased risk of depression, anxiety, and other mental health issues. However, there are various treatments available, including hormone replacement therapy, antidepressants, and therapy. It's essential to work closely with a healthcare provider to determine the best course of treatment. Additionally, practicing self-care can help manage the symptoms of perimenopause and improve overall mental health.

Citations:

  • Freeman, E. W., Sammel, M. D., Liu, L., & Gracia, C. R. (2004). Depression in the menopause transition: hormone and psychosocial correlates. Obstetrics and gynecology clinics of North America, 31(3), 477–496. https://doi.org/10.1016/j.ogc.2004.05.003

  • Soares, C. N., & Poitras, J. R. (2020). Hormones and mood in perimenopause and postmenopausal women. Psychopharmacology, 237(5), 1363–1380. https://doi.org/10.1007/s00213-019-05372-4

Top 5 Anxiety Coping Strategies At Home

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Anxiety is a common mental health condition that affects millions of people worldwide. It can cause intense feelings of fear, worry, and apprehension, and can significantly impact daily life. Fortunately, there are several psychotherapy at-home tools and strategies that can help individuals reduce their anxiety symptoms. In this blog post, we will discuss the top 5 most effective tools and strategies for managing anxiety.

  1. Cognitive Behavioral Therapy (CBT) CBT is a type of psychotherapy that focuses on identifying and changing negative thought patterns and behaviors. It has been shown to be effective in treating anxiety disorders, including generalized anxiety disorder, panic disorder, and social anxiety disorder. One of the key components of CBT is learning how to challenge and replace negative thoughts with more realistic and positive ones. This can be done through various techniques, such as keeping a thought diary, practicing mindfulness, and using positive affirmations.

  2. Relaxation Techniques Relaxation techniques, such as deep breathing, progressive muscle relaxation, and guided imagery, can help individuals reduce feelings of anxiety and promote relaxation. Deep breathing involves taking slow, deep breaths and focusing on the sensations of the breath as it enters and leaves the body. Progressive muscle relaxation involves tensing and then relaxing different muscle groups in the body, one at a time. Guided imagery involves visualizing calming and peaceful images, such as a beach or a forest.

  3. Exercise Exercise is a natural mood booster and has been shown to be effective in reducing symptoms of anxiety. Regular exercise can help individuals reduce stress, increase feelings of well-being, and improve overall physical health. Exercise can be any activity that gets the heart rate up, such as running, cycling, swimming, or walking. Even low-impact exercises like yoga and tai chi have been shown to be effective in reducing anxiety symptoms.

  4. Mindfulness Meditation Mindfulness meditation involves focusing on the present moment and letting go of distracting thoughts and worries. It has been shown to be effective in reducing symptoms of anxiety, depression, and stress. Mindfulness can be practiced in various ways, such as through formal meditation practices or through informal practices like mindful breathing or mindful eating.

  5. Social Support Social support is crucial for individuals with anxiety, as it can provide a sense of comfort, validation, and encouragement. Spending time with friends and family, joining support groups, and seeking out professional help are all effective ways to receive social support. It is essential to surround oneself with people who are supportive, empathetic, and understanding.

Research has shown that these psychotherapy at-home tools and strategies can be effective in reducing anxiety symptoms. However, it is important to remember that these strategies should not replace professional treatment for individuals with severe anxiety. A qualified mental health professional can provide more personalized treatment, including medication and therapy.

Medical Citations and Research:

  1. Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive therapy and research, 36(5), 427-440.

  2. Meuret, A. E., & Ritz, T. (2010). Hyperventilation in panic disorder and asthma: Empirical evidence and clinical strategies. International journal of psychophysiology, 78(1), 68-79.

  3. Stubbs, B., Vancampfort, D., Rosenbaum, S., Firth, J., Cosco, T., Veronese, N., ... & Koyanagi, A. (2017). An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis. Psychiatry research, 249

Hormone Replacement Therapy for Women: The Basics!

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As women approach menopause, their bodies undergo significant hormonal changes that can lead to a wide range of uncomfortable symptoms. Hot flashes, mood swings, and trouble sleeping are just a few of the unpleasant side effects that can arise during this transitional period. For many women, hormone replacement therapy (HRT) is an effective way to manage these symptoms and improve their overall quality of life. However, like any medical treatment, HRT comes with both benefits and risks. In this blog post, we'll explore the potential benefits and risks of HRT, as well as some common side effects to be aware of.

Benefits of Hormone Replacement Therapy

For women experiencing perimenopausal symptoms, HRT can be a game-changer. By restoring hormone levels to their pre-menopausal levels, HRT can help reduce the severity and frequency of symptoms like hot flashes, night sweats, and mood swings. HRT can also improve bone density, which is particularly important for women at risk of osteoporosis.

Another benefit of HRT is its ability to improve vaginal health. As women age, the walls of the vagina can become thinner and dryer, leading to discomfort and pain during sex. HRT can help alleviate these symptoms by restoring moisture to the vaginal area and improving the overall health of vaginal tissue.

Risks of Hormone Replacement Therapy

While there are many benefits to HRT, there are also some potential risks that should be taken into consideration. One of the most significant risks associated with HRT is an increased risk of breast cancer. However, it's important to note that this risk is relatively small, particularly for women who use HRT for a short period of time.

HRT can also increase the risk of blood clots, stroke, and heart disease. Again, the risk of these conditions is relatively low, but it's important to talk to your doctor about your individual risk factors before starting HRT.

Common Side Effects of Hormone Replacement Therapy

Like any medication, HRT can have some side effects. Some of the most common side effects of HRT include:

  • Headaches

  • Breast tenderness

  • Nausea

  • Bloating

  • Mood swings

These side effects are generally mild and tend to go away on their own within a few weeks of starting HRT. However, if you experience any of these symptoms and they persist or worsen, it's important to talk to your doctor.

In addition to these common side effects, HRT can also increase the risk of less common side effects like blood clots, stroke, and heart disease. Again, it's important to talk to your doctor about your individual risk factors before starting HRT.

Overall, Hormone Replacement Therapy can be an effective way to manage the symptoms of perimenopause and improve quality of life for women. However, it's important to weigh the potential benefits and risks before starting HRT, and to work closely with your doctor to monitor your hormone levels and any potential side effects.

Citations:

  • North American Menopause Society. (2017). The 2017 hormone therapy position statement of the North American Menopause Society. Menopause (New York, N.Y.), 24(7), 728–753. https://doi.org/10.1097/GME.0000000000000921

  • Manson, J. E., Chlebowski, R. T., Stefanick, M. L., Aragaki, A. K., Rossouw, J. E., Prentice, R. L., Anderson, G., Howard, B. V., Thomson, C. A., & Lacroix, A. Z. (2013). Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health

Ketamine as a potential treatment for Substance Use Disorder (SUD)

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As an expert in clinical psychiatry, I've been keeping an eye on the latest research on ketamine as a potential treatment for substance use disorder (SUD). While still in the early stages of research, ketamine has shown promising results for treating SUDs, particularly in cases of opioid addiction.

Ketamine is a dissociative anesthetic that has been used for decades in medical settings. In recent years, it's been studied for its potential use in treating a range of mental health conditions, including depression, anxiety, and post-traumatic stress disorder (PTSD). But now, researchers are looking at ketamine's potential as a treatment for addiction.

How does ketamine work?

Ketamine works by blocking a specific receptor in the brain called the NMDA receptor. This receptor plays a role in the brain's reward system, which is involved in addiction. By blocking this receptor, ketamine may be able to reduce the brain's response to drugs and alcohol, making it easier to quit using them.

Benefits of Ketamine for SUD Treatment

One of the most promising aspects of ketamine as a SUD treatment is its potential to provide quick relief from withdrawal symptoms. Withdrawal symptoms can be incredibly uncomfortable and often lead to relapse. But a small study conducted in 2018 found that ketamine was able to significantly reduce withdrawal symptoms in people with opioid use disorder.

Another potential benefit of ketamine is its ability to quickly reduce cravings for drugs and alcohol. In a study published in 2021, researchers found that ketamine was able to reduce alcohol cravings in people with alcohol use disorder. This reduction in cravings could make it easier for people to stay sober in the early stages of recovery.

Finally, ketamine has been shown to have a relatively low risk of addiction itself, making it a potentially safer option than other medications commonly used to treat addiction, such as methadone and buprenorphine.

Potential Drawbacks of Ketamine for SUD Treatment

While ketamine shows promise as a SUD treatment, there are also potential drawbacks to consider. For one, ketamine is a powerful anesthetic that can have serious side effects when not used properly. Additionally, ketamine is currently not approved by the U.S. Food and Drug Administration (FDA) for the treatment of addiction, meaning it may not be covered by insurance and may only be available through clinical trials or off-label use.

There are also concerns about the potential for abuse and misuse of ketamine, particularly in the context of addiction treatment. While ketamine has a relatively low risk of addiction, it can still be abused and can have serious negative effects on a person's mental and physical health.

Conclusion

Overall, ketamine shows promise as a potential treatment for substance use disorder, particularly in cases of opioid addiction. However, more research is needed to fully understand its safety and efficacy for SUD treatment. If you or someone you know is struggling with addiction, it's important to speak with a healthcare provider about all available treatment options.

References:

Cohen, J. A., & Li, R. (2021). Ketamine for alcohol use disorder: A systematic review. Journal of Substance Abuse Treatment, 129, 108341.

Lee, M., Silverman, S. M., Hansen, H., Patel, V. B., & Manchikanti, L. (2018). A comprehensive review of opioid-induced hyperalgesia. Pain Physician, 21(2), 145-161.

Let's talk about the potential long term side effects of antidepressants (SSRIs)

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Depression is a serious mental health condition that affects millions of people worldwide. Luckily, there are a variety of treatment options available to help those struggling with depression, including therapy, lifestyle changes, and medications. One of the most common medications prescribed for depression are selective serotonin reuptake inhibitors (SSRIs), which work by increasing levels of serotonin in the brain. However, while SSRIs are generally considered safe and effective, there are some potential long-term side effects that patients should be aware of.

First, let's talk about some of the most commonly prescribed SSRIs. You've probably heard of Prozac, Zoloft, Paxil, Celexa, and Lexapro - they're some of the most commonly prescribed medications for depression. They're often considered a first-line treatment because they're effective and relatively easy to tolerate. However, it's important to note that different SSRIs can work differently for different people. Some people may respond better to one SSRI over another, so it's important to work with your doctor to find the best medication for you.

Now, let's talk about the potential long-term side effects of SSRIs. One of the most commonly reported side effects is sexual dysfunction. This can include decreased libido, difficulty achieving orgasm, and erectile dysfunction. While these side effects can be frustrating, it's important to note that they're usually temporary and can often be managed by adjusting the dosage or switching to a different medication.

Another potential side effect of long-term SSRI use is weight gain. This is because SSRIs can affect the way your body processes certain hormones and neurotransmitters, which can lead to an increase in appetite and a decrease in metabolism. However, it's important to note that not everyone who takes SSRIs will experience weight gain, and that lifestyle factors like diet and exercise can also play a role.

One potential long-term side effect of SSRIs that is less commonly discussed is the risk of bone loss. Studies have shown that long-term use of SSRIs can lead to a decrease in bone mineral density, which can increase the risk of fractures and osteoporosis. This is particularly concerning for older adults who may already be at risk for bone loss.

So, what can you do to mitigate the potential long-term side effects of SSRIs? First, it's important to work with your doctor to find the right medication and dosage for you. They can also monitor you for potential side effects and make adjustments as needed. Additionally, making lifestyle changes like maintaining a healthy diet and exercise regimen can help offset some of the potential weight gain associated with SSRIs. Finally, if you're concerned about the potential risk of bone loss, make sure to talk to your doctor about getting a bone density test and taking steps to maintain bone health.

While SSRIs are generally considered safe and effective for the treatment of depression, it's important to be aware of the potential long-term side effects. By working with your healthcare provider and supporting yourself with healthy lifestyle considerations, you can help mitigate these risks and continue to manage your depression effectively. Remember, depression is a treatable condition, and there is no shame in seeking help.

References:

  1. Santarelli L, Saxe M, Gross C, et al. Requirement of hippocampal neurogenesis for the behavioral effects of antidepressants. Science. 2003;301(5634):805-809.

  2. Frodl T, Jäger M, Smajstrlova I, et al. Effect of hippocampal and amygdala volumes on clinical outcomes in major depression: a 3-year prospective magnetic resonance imaging study. J Psychiatry Neurosci. 2008;33(5):423-430.

  3. MacQueen GM, Yucel K, Taylor VH, et al. Posterior hippocampal volumes are associated with remission rates in patients with major depressive disorder. Biol Psychiatry. 2008;64(10):880-883.

  4. Warner-Schmidt JL, Duman RS. VEGF as a potential target for therapeutic intervention in depression. Curr Opin Pharmacol. 2008;8(1):14-19.

  5. Clayton AH, Pradko JF, Croft HA, et al. Prevalence of sexual dysfunction among newer antidepressants. J Clin Psychiatry. 2002;63(4):357-366.

  6. Serretti A, Chiesa A. Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis. J Clin Psychopharmacol. 2009;29(3):259-266.

  7. Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F. Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. J Clin Psychiatry. 2001;62 Suppl 3:10-21.

  8. Kanakam N, Raipally JR. Long-term sexual dysfunction following selective serotonin reuptake inhibitor (SSRI) antidepressant use: a narrative review. Sex Med Rev. 2021;9(1):38-46.

  9. Csoka AB, Bahrick A, Mehtonen O-P. Persistent sexual dysfunction after discontinuation of selective serotonin reuptake inhibitors. J Sex Med. 2008;5(1):227-233.

  10. Richards JB, Papaioannou A, Adachi JD, et al. Effect of selective serotonin reuptake inhibitors on the risk of fracture. Arch Intern Med. 2007;167(2):188-194.

  11. Haney EM, Chan BK, Diem SJ, et al. Association of low bone mineral density with selective serotonin reuptake inhibitor use by older men. Arch Intern Med. 2007;167(12):1246-1251.

  12. van den Brand MW, Pouwels S, Samson MM, et al. Use of antidepressants and bone mineral density in older adults: the B-PROOF study. J Bone Miner Res. 2017;32(4):718-726.

What can ketamine actually treat??

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Ketamine has been the subject of much attention in recent years due to its potential as a treatment for a range of mood disorders. Depression, anxiety, PTSD, OCD, eating disorders, trauma, chronic pain, treatment-resistant depression, suicidal ideation, and other mental health diagnoses have all been the focus of studies investigating ketamine's efficacy as a treatment option. I have read most of the published studies on this topic and will now share with you a summary of what we know about the use of ketamine in treating these various mood disorders.

Depression is one of the most common mood disorders, affecting millions of people worldwide. Clinical trials have shown that ketamine can have rapid and long-lasting antidepressant effects in those with treatment-resistant depression. In fact, some studies have reported that patients who received repeated ketamine infusions experienced a significant improvement in symptoms within hours of treatment. These effects have been found to persist for up to several weeks after treatment.

Similarly, ketamine has also shown promise as a treatment for anxiety disorders. Studies have found that ketamine infusions can reduce symptoms of anxiety, such as panic attacks and generalized anxiety, in patients with treatment-resistant anxiety disorders.

Post-traumatic stress disorder (PTSD) is another mood disorder that has been the focus of several ketamine studies. Research has found that ketamine can reduce symptoms of PTSD, including hyperarousal, avoidance, and re-experiencing, with effects lasting for several days or weeks.

Obsessive-compulsive disorder (OCD) is another mood disorder that has been the subject of ketamine research. A randomized controlled trial found that ketamine reduced OCD symptoms in patients who had not responded to other treatments, such as selective serotonin reuptake inhibitors (SSRIs).

Eating disorders, such as anorexia nervosa and binge eating disorder, have also been studied in the context of ketamine treatment. One study found that ketamine reduced binge eating episodes in patients with both anorexia nervosa and binge eating disorder, potentially due to its effect on altering plasma levels of endocannabinoids.

Chronic pain is another condition that ketamine has been investigated for. Research has found that ketamine can be an effective treatment for chronic pain, particularly neuropathic pain, with effects lasting for several weeks after treatment.

Finally, ketamine has also been studied as a treatment for suicidal ideation. One study found that a single ketamine infusion reduced suicidal thoughts in patients with treatment-resistant depression, with effects lasting for up to a week.

In summary, ketamine has shown promise as a treatment for a range of mood disorders, including depression, anxiety, PTSD, OCD, eating disorders, chronic pain, and suicidal ideation. While further research is needed to fully understand the mechanisms underlying ketamine's effects and to optimize dosing and administration, the results of these studies are promising and offer hope for those struggling with these conditions.

Citations:

  1. Newport, D. J., Carpenter, L. L., McDonald, W. M., Potash, J. B., Tohen, M., Nemeroff, C. B., & APA Council of Research Task Force on Novel Biomarkers and Treatments. (2015). Ketamine and other NMDA antagonists: Early clinical trials and possible mechanisms in depression. The American journal of psychiatry, 172(10), 950–966. https://doi.org/10.1176/appi.ajp.2015.15040465

  2. Murrough, J. W., Perez, A. M., Pillemer, S., Stern, J., Parides, M. K., aan het Rot, M., Collins, K. A., Mathew, S. J., & Charney, D. S. (2013). Rapid and longer-term antidepressant effects of repeated ketamine infusions in treatment-resistant major depression. Biological psychiatry, 74(4), 250–256. https://doi.org/10.1016/j.biopsych.2012.06.022

  3. Feder, A., Parides, M. K., Murrough, J. W., Perez, A. M., Morgan, J. E., Saxena, S., Kirkwood, K., Aan Het Rot, M., Lapidus, K. A., Wan, L. B., Iosifescu, D., & Charney, D. S. (2014). Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: a randomized clinical trial. JAMA psychiatry, 71(6), 681–688. https://doi.org/10.1001/jamapsychiatry.2014.62

  4. Krystal, J. H., Davis, L. L., Neylan, T. C., Raskind, M. A., Schnurr, P. P., Stein, M. B., Vessicchio, J. C., Shiner, B., Gleason, T. C., Huang, G. D., & Pietrzak, R. H. (2018). It is time to address the crisis in the pharmacotherapy of posttraumatic stress disorder: a consensus statement of the PTSD Psychopharmacology Working Group. Biological psychiatry, 84(10), 730–736. https://doi.org/10.1016/j.biopsych.2018.05.017

  5. Rodriguez, C. I., Kegeles, L. S., Levinson, A., Feng, T., Marcus, S. M., Vermes, D., Flood, P., & Simpson, H. B. (2013). Randomized controlled crossover trial of ketamine in obsessive-compulsive disorder: proof-of-concept. Neuropsychopharmacology, 38(12), 2475–2483. https://doi.org/10.1038/npp.2013.150

  6. Pedraz, M., López-Moreno, J. A., De la Torre, R., Garcés-Robles, M. A., Campos-Campos, M. A., Parcet-Ibars, M. A., García-Caldentey, J., & Alonso, P. (2020). Ketamine reduces binge eating and alters plasma levels of endocannabinoids in patients with both anorexia nervosa and binge eating disorder: a randomized controlled trial. Translational psychiatry, 10(1), 1–12. https://doi.org/10.1038/s41398-020-010

Summary of IV Ketamine Research in the Treatment of Chronic Depression

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This post may feel a bit “dry” but is a succinct summary of the current research regarding IV ketamine in TRD (treatment resistant depression). Would love to hear your comments and questions!

Introduction

Depression is a common mental health disorder that affects millions of people worldwide. Despite the availability of various treatment options, a significant proportion of individuals with depression do not respond to conventional antidepressant medications. Such individuals are said to have treatment-resistant depression (TRD). Recently, ketamine has emerged as a potential alternative treatment option for TRD. Ketamine is a dissociative anesthetic that has been used for several years in anesthesia and pain management. In this article, we summarize the current research findings on the use of intravenous ketamine for TRD.

Ketamine MOA (mechanism of action)

Ketamine is primarily a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist. It also has agonist effects on the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor. These receptor interactions lead to an increase in glutamate release and activation of downstream signaling pathways that promote synaptic plasticity and neurogenesis. It is thought that these effects of ketamine may underlie its antidepressant effects. 

Clinical trials

Several randomized controlled trials (RCTs) have evaluated the efficacy of intravenous ketamine for TRD. In a meta-analysis of 11 RCTs, Caddy et al. (2015) found that ketamine was significantly more effective than placebo in reducing depressive symptoms in individuals with TRD. The effect size was moderate to large, and the antidepressant effects were rapid, with significant improvement observed within hours of administration. The duration of the antidepressant effects varied between studies, ranging from a few days to several weeks. In a subsequent meta-analysis of 20 RCTs, Zheng et al. (2020) also found that ketamine was more effective than placebo in reducing depressive symptoms in individuals with TRD. The effect size was large, and the antidepressant effects were rapid, with significant improvement observed within 24 hours of administration. The duration of the antidepressant effects varied between studies, ranging from a few days to several weeks. In addition to RCTs, several open-label studies and case series have also reported positive results with intravenous ketamine for TRD (Murrough et al., 2013; Phillips et al., 2014; Wilkinson et al., 2018). These studies have also reported rapid and sustained antidepressant effects with ketamine.

Safety of Therapeutic Ketamine

The safety and tolerability of intravenous ketamine for TRD have also been evaluated in several studies. In general, ketamine was well-tolerated, with the most common side effects being dissociative and cognitive effects. These effects were usually transient and resolved within hours of administration. Other side effects reported included nausea, dizziness, and headache. However, there have been concerns about the potential for abuse and dependence with ketamine. To address these concerns, several studies have evaluated the abuse potential and cognitive effects of ketamine in individuals with a history of substance abuse. In a study by Morgan et al. (2010), ketamine was found to have low abuse potential and did not produce significant cognitive impairment in individuals with a history of substance abuse.

Limitations

Despite the promising results, there are several limitations to the current research on ketamine for TRD. First, most studies have been conducted in small sample sizes, which limits the generalizability of the findings. Second, the optimal dosing and frequency of ketamine administration for TRD are not well-established. Finally, the long-term safety and efficacy of ketamine for TRD are not known.

Conclusion

Intravenous ketamine has emerged as a important potential alternative treatment option for TRD. The antidepressant effects of ketamine are rapid and sustained, with a large effect size. Ketamine is generally well-tolerated by patients.

 

Ketamine Treatment Versus Ketamine Assisted Psychotherapy

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Ketamine Journey

This patient is relaxing comfortably while receiving a ketamine assisted therapy session in office.

Introduction:

Many people are aware that in the last several decades, there has been a tremendous resurgence of medical research into the therapeutic potential of ketamine for patients with chronic depression and/or anxiety.  Patients may be unclear as to what their options are for ketamine treatment, and we would like to outline and clarify the most common types of ketamine treatment here.

Intravenous Ketamine Treatment:

Throughout the United States, there has been an explosion over the past decade of ketamine treatment being used in outpatient clinics for the treatment of treatment-resistant depression, generalized anxiety, and chronic pain.

These ketamine clinics specialize in a particular treatment protocol that has been shown in several studies to rapidly benefit patients who are in deep chronic depression, have acute suicidal ideation, and are suffering from chronic pain without adequate relief.  

This treatment series consists of a “loading dose” of ketamine with two infusions per week for three weeks.  This loading series helps to jumpstart and augment synaptogenesis in the brain, which is the process by which neurons grow, connect, and communicate with each other. Ketamine works on well over a dozen receptor sites and neurotransmitters in the body, and its mechanism of action is still not entirely well understood due to its wide array of effects.  

After the loading series is complete (6 treatments in all), booster IV sessions are typically recommended to maintain the benefits of treatment.  Boosters are recommended on an individual basis based on a patient’s response to treatment but typically start with the first booster 2 weeks after the last session in the loading series, then anywhere between 2 weeks to 3 months later depending on how well the benefits are maintained.

IV ketamine treatment is typically structured in an outpatient clinic setting with little or no “talk therapy” component, although many clinics are beginning to create a “set and setting” that will facilitate the psychotherapeutic healing potential of ketamine along with its biomedical benefits. 

The duration of the IV treatment itself is typically 40 minutes but the entire appointment time may be 90-min to 2 hours to give the patient adequate time to settle in, get treatment and rest before going home.

During IV treatment, a patient will have a vital signs monitor recording oxygen levels, heart rhythm, and blood pressure throughout treatment, but most clinics provide a very comfortable setting that doesn’t feel too “medical”. 

Ketamine Assisted Psychotherapy:

Ketamine Assisted Psychotherapy or KAP is more focused on the healing benefits to the psyche (mind) and soma (body) that ketamine journeys can provide for patients.  Like MDMA and other psychedelic medicines, ketamine at certain doses will induce a full psychedelic-altered state of consciousness that allows patients to better access their emotions, memories, visions, and body sensations than they can in “normal waking” consciousness.  

KAP is typically provided in-office by a counselor, therapist, or another healthcare provider with sufficient training to be able to guide patients through the process of preparation, ketamine journey, and integration to facilitate healing and transformation.  

Common themes that patients are interested in working on with ketamine-assisted psychotherapy include health concerns such as chronic depression, anxiety, and PTSD. Patients also come in looking to discover life purpose, resolve trauma in the body, heal feelings of disconnection, or search for spiritual fulfillment and transcendent experiences.  Others find relief near the end of life from anxiety or heal from existential fear.  

Ketamine Assisted Psychotherapy sessions are typically between 2-3 hours in length and the ketamine itself is most commonly administered as an oral “lozenge” that dissolves slowly in the mouth over 10-15 minutes.  Patients can take lower doses of ketamine (approximately 50mg-100mg) as a “psycholytic” dose, meaning they are less likely to be in a full psychedelic journey but feel more open and available to deep psychotherapy discussions and their own emotions.  At higher doses (100mg +) a full psychedelic journey can be experienced with alterations in body sensations, visualizations, altered perceptions of time and space, etc… These journeys are accompanied by relaxing music that is chosen to facilitate healing experiences and release from the body and emotions.

Ketamine journeys are followed up by a process of integration, which involves “unpacking” the material that came up during the journey state and helps to create meaningful change in everyday life.  Integration helps to reinforce the new connections and insights that arise during journey states and provides a clear plan to help patients move forward from the new lens or shifts in perspective they experience with ketamine.  

Ketamine Treatment Methods: Intravenous, Intramuscular, and Oral Dosing

There are a multitude of “routes of administration” for ketamine treatment and ketamine-assisted psychotherapy.  Some of the most common include IV (intravenous), IM (intramuscular), and Oral (typically a lozenge or rapid dissolve tablet).  Each of these different dosing strategies has benefits and drawbacks, and there is no one-size-fits-all approach to ketamine treatment.  

Things to consider for patients who are seeking ketamine treatment include: 

What are the ultimate goals of treatment for you at this time?  Exploring and releasing trauma?  Symptom relief from anxiety/depression/suicidal ideation?  Support for existential fears or fear of death and dying?  Exploring an altered state of consciousness for personal and/or spiritual growth?

Knowing what your specific goals for treatment are will help guide your healthcare provider or therapist in determining which treatment option might be the best for you at this time.  I also counsel patients to consider that we can start with one type of ketamine treatment and “fine tune” the process over time for what your body needs.

Other considerations for patients looking at ketamine treatment include the time commitment, financial investment, and psychic or emotional “space” for being able to truly benefit and integrate what comes up during these treatment sessions.  

Ketamine treatments are typically between 2-3 hours per session, and depending on what type of treatment you are seeking, can be once or twice weekly at first.  Most patients working with ketamine will end up spreading out treatments after an initial “series” takes place.  

IV Ketamine Breakdown:

Time commitment: 90 minutes to 2 hours total time in clinic

Cost: $450-$600 per treatment

Frequency of Treatment: 2x per week for 3 weeks, then booster dosing every 1-3 months as needed

Duration of Experience: 40-50 minute sustained IV journey

Experience: Can be sub-psychedelic or full psychedelic journey depending on treatment goals, level of comfort the patient has in an altered state of consciousness, ability/desire of the provider to hold space for psychedelic work (some IV clinics are more clinical, some are more psychedelic in orientation)

Benefits: The highest level of bioavailability of the medicine at 98%, most medical monitoring during treatment for safety, highest quality of medical research done on this loading series for the treatment of acute suicidal ideation, treatment-resistant depression, and anxiety

Drawbacks: Expense, higher level of “medical monitoring” during treatment, may not include the helpful psychedelic component of therapy and integration

IM Ketamine Breakdown:

Time commitment: 2-3 hours total time in the clinic

Cost: $400-$600 per treatment

Frequency of Treatment: 1x weekly for 4-8 weeks, sometimes these treatments are more spread out (once every other week or once per month)

Duration of Experience: 30-60 minute journey including “take-off”, peak and “landing”

Experience: More likely to be a full psychedelic journey.  This can feel very intense for patients as the onset of action is rapid and the peak of the experience happens quickly.  IM ketamine can be used at a very low dose to support a psychotherapy session or at higher doses to induce a full psychedelic journey state.  Generally a little less predictable in terms of the level of intensity of the experience and duration of the experience.  This variability relates to how the body metabolizes ketamine which is very individual.

Benefits: High bioavailability, approximately 93%.  The patient does not need to be hooked up to any medical equipment during treatment, and can be used in a regular office setting.  Can help patients who don’t tolerate oral ketamine (meaning they have side effects like nausea).  Rapid journey time allows for more integration after the session.

Drawbacks: Less predictable experiences, can be very intense for patients leading to higher levels of anxiety or difficulty integrating the experience.

Oral Ketamine-Assisted Psychotherapy:

Time Commitment: 2-3 hours in the clinic

Cost: $400-$600 per treatment

Frequency of Treatment: 1x weekly for 4-8 weeks, sometimes these treatments are more spread out (once every other week or once per month)

Duration of Experience: 60-75 minutes, not including “take-off” and “landing”

Experience: Helpful “bell curve” experience where a patient has time during the initial part to feel themselves moving into the altered state, time at the peak, and then a softer landing afterward.  Dosing can be variable to induce a mellow psycholytic experience or higher to provide a full psychedelic journey.

Benefits: Generally well-tolerated and most patients feel good with having a soft take-off and landing with oral ketamine.  Easy to use in the office, no extra medical monitor required.  Patients get the prescription sent to them and can choose to do to the therapy in the office with a counselor or at home in some cases.

Drawbacks: Tends to have more side effects including nausea, dizziness, and headache due to the slower oral absorption via the digestive tract.  Some patients don’t like the taste although pharmacies will flavor lozenges.  

Ketamine Across the Spectrum CE Event

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Dear Oregon NDs,

I’m absolutely thrilled to announce that I’m presenting with a host of amazing ketamine providers this February! It’s an almost all day CE event for FREE and will cover your 4 hours pharmacy ketamine CEU and 2 hours ketamine ethics CEU. Here’s the EventBrite link, we hope you’ll join us:

https://www.eventbrite.com/e/ketamine-treatment-across-the-dose-spectrum-tickets-498272395147?utm-campaign=social&utm-content=attendeeshare&utm-medium=discovery&utm-term=listing&utm-source=cp&aff=escb

How can I help you, REALLY?

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When people leave my office and I’ve done my job well, they feel EXCITED, NERVOUS, INSPIRED and AWARE of themselves in a totally new way.   

People come in deep pain or suffering, feeling numb or disconnected, feeling depressed, stuck, or angry and they need someone to help them SEE what’s driving these patterns before they can change them. 

What I do for my patients is sometimes REALLY difficult to explain.  I help people with a huge variety of health issues, mental-emotional pain, feeling depressed and stuck, and relationship struggles, I love it all.  The reason that I have a hard time pinning down one type of problem or one type of person that I can help is that the PHILOSOPHY and METHOD of what I do is….ANY problem a patient comes in with is a “way in”.

What I mean by a “way in” is that any problem that a patient has will lead us to the deeper layers of internalized, unconscious patterns that are keeping them stuck.  Any story, example, or narrative that they may have come into the office with is what we will use to TRACK back into their own wounding and pain that they may not see….because it’s unconscious.

The process of tracking those patterns from the outside world to the patient’s inner world is the KEY to uncovering the unconscious, internalized painful patterns and energetic CONTRACTS that we’ve all made to keep ourselves OUT of the painful places (even though what ends up happening is we repeat our painful experiences over and over again). 

MY job is to be the expert TRACKER, the person who can help you navigate the self-created defenses (the WALL is another word for this) and ultimately find the WOUND underneath these defenses. We work on opening up to the wound and then ask higher self or The Universe to reveal the healing and connection underneath.

 How does this happen?

We start with discussing WHY someone is feeling bad/stuck/painful….often why they are really stuck is DEEPER than we think it is when we first start talking.  We will discuss your STORIES/NARRATIVES about how you think, see, feel and react to situations that are “triggering” to you in life. 

We often find there are one or two CORE THEMES of painful past experiences or dysfunctional patterns that are driving our actions and reactions but even if we KNOW about these patterns (or have talked them to death with a therapist) we may not FEEL them or know how to RELEASE yourself from their grasp on your life. 

The METHOD of tracking is really hearing the story, tracking my own feelings and patterns in myself at the same time, and asking my higher self or Spirit to reveal and uncover the healing that needs to happen under the WOUNDED painful places.  I will sometimes see images, hear specific messages, or be asked to do bodywork to help someone take the plunge into the next phase of healing and releasing these patterns. 

I will give specific HOMEWORK which usually includes challenging questions or prompts to think about (or journal) and assignments to start bringing these wounded parts forward for healing inside ourselves and our relationships with others. We also work with healing patterns of dysfunction with money, rage, abuse, work, you name it!

Is this process painful sometimes?  Yes, but you are ALREADY in deep pain and doing the same things you’ve been doing for years are not helping get you OUT. 

There’s a TRICKSTER energy or archetype at play here.  This TRICKSTER (a universal part of the psyche) is keeping us stuck in the painful patterns BY ANY MEANS NECESSARY. 

And he’s doing a great job because you’re still stuck and you’re here seeking help.  I will help you track down and DEFEAT this trickster energy inside of you…you will see this mechanism unwind and feel EMPOWERED instead of a victim to your life.

In a nutshell, it’s time to let yourself get OFF the Hampster Wheel of terrible painful suffering and start living again!!!

Finding Your Voice with Psychedelics

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This quick 5-minute video addresses a really common theme I see in patients working with altered states of consciousness and psychedelic medicines. We are so often suppressed, rejected or feel defeated in voicing our true authentic views and opinions in the world. It takes practice to find your voice and heal the wounds around authentic expression. Let me know what you think about these quick tips!

Psychedelic Resource Guide

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This is a shortlist of some resources that patients and providers might want to know about when deciding to work with psychedelic-assisted therapy. These are programs with which I am deeply familiar and deeply trust, there are lots of other resources out there that are not included but these are a great place to start!

 

PIN Network (Portland Integration Network):

This is an awesome list serve of many psychedelic-assisted therapy providers in the Portland area.  I am a member of this network and have seen the incredible power of gathering practitioners to share resources, provide community support and refer patients to the right providers for their health and healing.

 

https://www.portlandintegrationnetwork.com

 

Psychedelic Support Network:

Check out these amazing articles on all things psychedelic healing related, there are also opportunities for online education and lots of CE opportunities for healers looking to integrate psychedelic medicine into their practices.

 

https://psychedelic.support/articles/

 

Fireside Project:

This organization has a mission to help people minimize harm or risk in using psychedelics for healing as well as help provide improved outcomes and benefits from using psychedelics.  This organization has awesome resources for people seeking psychedelic healing and it has an awesome peer to peer 24/7 hotline for peer to peer psychedelic support.

 

https://firesideproject.org/

 

Polaris Insight Center:

This is an amazing San Francisco based organization working to provide the best training available for ketamine assisted therapy providers.  They have many modules and recruit experts in the field of ketamine assisted therapy to help provide initial and ongoing support for providers who are helping patients with ketamine. 

 

https://www.polarisinsight.com/

 

Prati:

Another incredible organization offering the best in psychedelic research and trainings including ketamine assisted therapy.  They do a wonderful job of providing intense experiential trainings for providers which are transformative and ripple out to patients and clients.

 

https://pratigroup.org/

 

MAPS:

For decades MAPS has been the leader in moving psychedelic assisted therapy forward, especially for MDMA.  This organization is providing real world relief with MDMA for severe PTSD, OCD, Anxiety and Depression, check out their extensive research and training programs!

 

https://maps.org/