A recent Washington Post article suggests that ketamine is not helping those with depression. Indeed, the article suggests that ketamine clinics are taking advantage of desperate people suffering from depression with an unproven treatment. In many ways, we agree with the authors of this article. In one fundamental way, we do not.
Ketamine has proven extremely helpful for our patients. We see an 85% response rate based on multiple well-established depression scales. But the way we administer ketamine is quite different from the approximately 150 ketamine clinics scattered across the United States. See, most ketamine clinics follow a protocol of administering intravenous (IV) ketamine three times per week for two weeks. Everybody in these clinics gets six infusions in two weeks at a cost of between $2,000 and $3,000. And many of these patients do not feel better at all after two weeks of treatment. Many do feel better for a week or two, but then slip back into depression. So, all of that effort was a waste of time and money fostering hopelessness and despair.
This situation occurs because those who operate most clinics do not understand how ketamine actually works. Ketamine works by two major pathways. The first is the GSK-3 pathway which results in the rapid antidepressant and anti-suicidal benefit of ketamine. The second pathway is actually much more important. Ketamine activates the production of brain-derived neurotrophic factor (BDNF) which is the brain’s own repair inducer. Not only does ketamine increase BDNF, but it also increases the number of receptors to which BDNF binds. So over time, there is more repair factor and more receptors available to be activated by the repair factor. The outcome is that over a period of weeks, neuroplasticity and repair occurs in the brain. This leads to the reduction in depression, because depression causes the breakdown in circuits and damage to the brain.
Since it takes weeks for this neuroplasticity to fully develop, it should not be surprising that people do not feel better at the end of two weeks of ketamine treatment. Moreover, if it takes weeks for BDNF to work, why should a person get three infusions in one week? That makes no sense. On average, at Neuro-Luminance Brain Health Centers, our patients receive 4.3 infusions total in their entire treatment course over 5 to 7 weeks. Neuro-Luminance’s protocols save time, medication exposure, and money, yet yield a superior outcome. Indeed, if a patient is getting infusions 3 times per week, they will quickly spend more time and more money in two weeks than most patients spend in their entire lifetime at Neuro-Luminance Brain Health Centers Ketamine Infusion Center. Moreover, we provide individualized psychiatric care and individualized protocols.
The Washington Post article mentions a small study out of Stanford which suggests that ketamine works via opiate receptors. This is certainly true for its pain benefit at higher doses, but a large volume of animal studies supports the role of BDNF in ketamine’s antidepressant effect. Lastly, the authors pointedly state that ketamine is not FDA-approved for the treatment of depression. What most Americans do not know is that FDA-approval simply means that a company can advertise the drug for a specific disease. For example, aspirin is used to treat headaches, prevent strokes, prevent heart attacks, relieve pain, treat arthritis, and reduce fever; however, it is only FDA-approved for fever and pain relief. So, utilizing ketamine for depression is no different from using aspirin to prevent strokes and heart attacks. Don’t let them fool you with their rhetoric.
We have been operating our ketamine infusion clinic for over six years and have treated well over 600 patients. Ketamine is safe, if safely administered. We have seen no evidence of addiction and only 5% of our patients require more than seven infusions. We encourage you to explore an intelligent way to approach ketamine therapy.