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Treatment Resistant Depression

Ketamine is currently the only legal psychedelic medicine in use that has come to be well regarded for the immediate and rapid relief of depressive symptoms. Ketamine is classified as a Schedule III substance with an indication as a dissociative anesthetic.

For those unfamiliar with the term treatment resistant depression, it may be helpful to list the symptoms of major depressive disorder which are indicated as:

  • Feelings of sadness, tearfulness, emptiness or hopelessness

  • Angry outbursts, irritability or frustration, even over small matters

  • Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports

  • Sleep disturbances, including insomnia or sleeping too much

  • Tiredness and lack of energy, so even small tasks take extra effort

  • Reduced appetite and weight loss or increased cravings for food and weight gain

  • Anxiety, agitation or restlessness

  • Slowed thinking, speaking or body movements

  • Feelings of worthlessness or guilt, fixating on past failures or self-blame

  • Trouble thinking, concentrating, making decisions and remembering things

  • Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide

  • Unexplained physical problems, such as back pain or headaches

Patients who have tried multiple forms of treatment including talk therapy, antidepressants, Transcranial magnetic stimulation (TMS), Electroconvulsive therapy (ECT), and Vagus nerve stimulation (VNS) are indicated to have treatment resistant depression.

Research shows about 70% of treatment resistant depression patients respond positively to treatment after one to three sessions; and 30-60% of treatment resistant patients experience remission after six or more sessions.

What we have come to find is that everyone's experience is variable and the amount of sessions indicated is completely individualized based on the needs of the patient. While some people experience a quick response with a short series of treatments, for others it needs to be reinforced regularly on an ascendant curve with what we call "boosters". Booster sessions serve to promote increased well-being and address the threat of a depressive relapse.

Currently, most studies put the failure rate for treatment resistant depression with conventional antidepressants at about one-third of patients no matter how many agents are tried (Fekadu et al., 2009; Goldberg, Privett, Ustun, Simon, & Linden, 1998; Kessler et al., 2003; Kiloh, Andrews, & Neilson, 1988). While Ketamine is certainly not a miracle pill by any means, to have a new treatment that can effectively treat about half of those who are unresponsive and continue to suffer with depression can be quite life-changing for many treatment resistant depressive patients.

There is no doubt that Ketamine can be a transformative experience that can allow for a transcendence of ordinary mind and whose mind-altering effect can induce a dissociative state of consciousness. However, experiencing a psychedelic state of consciousness is not often necessary for one to reap the benefits of this quick-acting antidepressant. This is important to highlight, as not everyone will experience an altered state of consciousness, and many patients will assume that without the psychedelic experience you're "simply not doing it right." This is a complete misunderstanding of the therapeutic and psychiatric effects of Ketamine as a catalyst for increasing neuroplasticity and decreasing depressive symptoms; and often a really important topic of discussion during the integration process. No two sessions are the same and learning to curve our expectations and navigate our window of tolerance for discomfort or perfection is a vital part of the integration process.

Furthermore, most often a psychedelic experience with Ketamine is contingent on the dose and routes of administration. Ketamine is currently administered in three different ways including Intravenous (IV), Intramuscular (IM), and Oral/Sublingual. It should also be noted that practitioners have been able to treat patients successfully at low doses that create trance states but generally not with major psychedelic effects by IV and sublingual routes.

As a dissociative anesthetic Ketamine has a proven safety record and there are thousands of patients and thousands of experiences demonstrating that it is a safe and effective treatment for depression and other psychiatric conditions.

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