This is a summary of Sonya Collins’ article from WebMD. The full article can be found here. Jeff Winograd had tried virtually every antidepressant on the market, but by the time he was 45 years old he had hit rock bottom and felt paralyzed by depression. He tried ketamine, which helped him feel better. Ketamine was used in combat medicine during the Vietnam War and was later approved as an anesthetic for people. Emergency responders began to realize that the drug had powerful effects against depression and suicidal thoughts. Ketamine causes a dissociative experience, which can include feelings of unreality, visual and sensory distortions, a distorted feeling about one’s body, and temporary unusual thoughts and beliefs. Ketamine can cause unconsciousness, high blood pressure, dangerously slowed breathing, and long-term problems. But researchers have studied and administered it in controlled, clinical settings to help people who don’t get relief from other medications.
Receiving Ketamine Ketamine comes in several forms, including a nasal spray called esketamine (Spravato). It’s used to treat depression in adults who haven’t been helped by antidepressant pills, have major depressive disorder, or are suicidal. Ketamine is not approved by the FDA for mental health conditions, but some doctors will prescribe lozenges for at-home use. Stewart only sees patients with a diagnosis of treatment-resistant depression and starts them with six infusions spaced over 3 weeks. Most people go down to one infusion every 2 to 4 weeks. The IV infusion lasts about 40 minutes and the dissociative experience starts quickly. The patient looks asleep and doesn’t move or talk, but may comment on the music playing on their headphones.
Christa Coulter-Scott, 51, got treatment in a similar setting in Gainesville, GA, and says she didn’t want to wake up. She also says the lighting in her office looked brighter the next day, but she doesn’t know if that was a side effect of the treatment. Winograd describes feeling like he was floating in a color, where he didn’t have any of the weight of his real life.
Coming Back to Real Life
At Stewart’s clinic, patients are sat down and talked with after the mind-altering part of the ketamine experience is over. This process is called integration. Krystal encourages patients to continue with their psychotherapy after ketamine treatment, and says the nasal spray is only approved for use along with an oral antidepressant. Patients may return for a booster dose of antidepressants weeks, months, or years after their first series. There is no standard recommendation for when or if people need a booster dose.
Researchers are studying why some people who try ketamine for depression don’t have the drug “trip,” yet still report relief from depression. The brain can respond in a few different ways depending on the state it was in to begin with. Ketamine can help people with long-term depression regrow lost synapses. Ketamine may work in other ways in the brain, too, like helping nerve cells that are deactivated or weakened by depression get new glutamate receptors so that they can respond to glutamate again.
Research suggests that ketamine works through opioid receptors to have its antidepressant effects, which concerns some researchers. The spreading and tapering of treatments over time should help reduce this risk. Ketamine may be less addictive than opioids, but it’s not without its risks. It may also not be safe for people who have a history of substance abuse or schizophrenia. Coulter-Scott says she sleeps better at night, and still feels stress, but not the darkness and anxiety she had lived with until now.
Costs and Insurance Insurance will only cover the FDA-approved nasal spray called esketamine (Spravato), but not IV ketamine. An infusion costs about $450 and takes six infusions over 3 weeks to work. Some people don’t keep up with their treatments because they can’t afford to, or because they feel good but can’t. Winograd’s insurance disputes have prevented him from getting a booster, but the changes that the first series of treatments brought about have lasted.