How does ketamine treat depression?​

Research suggests that ketamine works to reduce depression by blocking glutamate via binding to N-methyl-D-aspartate (NMDA) receptors in the brain. Glutamate is a neurotransmitter that plays an important role in healthy brain function and regulating the nervous system. If glutamate receptors become and remain overstimulated, this may result in long term, chronic, or treatment resistant depression.

One popular theory about the efficacy of ketamine treatment for depression is it’s ability to repair neurons. A study published in 2018 showed that when people are exposed to long term stress, it wears away brain cells and can cause them to die off, resulting in depression. Chronic stress also weakens neural connections in the brain over time and depression can decrease the number of synapses in the brain.

While scientists are still studying the full effects, experts believe that ketamine’s interaction with brain receptors plays a pivotal role in its ability to effectively treat depression. Ketamine actually encourages the formation of new neurons, and can relieve symptoms quickly.

Ketamine works directly to restore neural connections. It binds to the NMDA receptor and releases a glutamate surge. This in turn releases growth factors, like BDNF (brain-derived neurotrophic factor), which help make new synaptic connections and paves healthier thought patterns in the brain.

The ketamine assisted therapy (KAT) journey starts with a comprehensive diagnostic intake. During the initial 75 minute psychiatric evaluation, we will determine your course of treatment with frequency of KAT sessions. Treatment is highly customizable, based on your needs and any financial or other constraints. Some individuals will receive two KAT sessions per week for 4 weeks, while others may only need one KAT session per week and others may be eligible for a hybrid of at-home ketamine sessions.

After the initial psychiatric evaluation, we will meet for one or more 55 minute preparation sessions before beginning KAT. Preparation sessions help to create a safe and supportive space to discuss and explore treatment goals and aspirations. Once you feel ready to embark on your KAT journey, we will schedule your first 2 hour in-office KAT dosing session. During the first KAT session, we will start at a low dose to determine your response to ketamine and you will also begin your journey with gaining insights into your thoughts, emotions, behaviors, and life circumstances.

In order to connect those insights to your broader life goals, we will meet for integration therapy sessions on a weekly basis. Integration therapy is a crucial component of KAT. It refers to the process of integrating and making sense of the experiences, insights, and emotions that arise during ketamine sessions. This will help you to process and integrate these experiences into your daily life, fostering personal growth and positive change. This may involve making changes in behavior, relationships, thought patterns, or lifestyle choices.

As we work together during this intimate journey, integrating the experiences can help you to more effectively embody the insights and transformations catalyzed by ketamine-assisted therapy. Patryce Bak, PMHNP will also support you by recommending any integrative therapies needed to meet your unique needs (nutraceuticals, herbs, diet, etc.).

What is it like to receive ketamine treatment ?

Ketamine comes in different forms – intravenous (IV), intramuscular (IM), nasal spray (IN) and sublingual (SL) tablets or troches. Currently, Transcend Psychiatric is offering IM, IN and SL ketamine. Intramuscular is the preferred method for in-office ketamine sessions. Sublingual or intranasal ketamine administration allows for hybrid in-clinic and at-home treatment options.

Your in-clinic KAT session will be held in a beautiful and calming environment and facilitated by psychiatric nurse practitioner and Reiki practitioner, Patryce Bak, PMHNP-BC. When you enter the healing therapy room, an immersive and transformative experience begins. Before you begin the dosing session we will discuss your intentions for the session, and depending on your preferences, we may prepare for your journey with ceremonial elements. We will also collect your blood pressure and other vitals.

Once it’s time to begin the medicine session, you will receive an injection into the deltoid muscle in your upper arm. The feeling is described as relaxing and meditative by most of our patients. The session is a total of 2 or 3 hours allowing for the effects of ketamine to wear off within 1-1.5 hours. During the second or third hour most clients share about their ketamine journey experience and we begin the integration process. Once you are ready you go home, a friend or ride share service must pick you up. You should plan to rest for the remainder of the day and if possible, engage in self-care activities.

Ketamine and ketamine assisted therapy have shown potential for the treatment of various conditions, including:

Depression: Ketamine has demonstrated rapid and significant antidepressant effects, particularly in treatment-resistant depression. It may be used as an alternative treatment when traditional antidepressant medications have been ineffective.

Anxiety disorders: Ketamine has shown promise in reducing symptoms of anxiety disorders, including generalized anxiety disorder (GAD), social anxiety disorder, and post-traumatic stress disorder (PTSD).

Bipolar disorder: Ketamine may be used as an adjunctive treatment for bipolar disorder, particularly in managing depressive episodes. However, it is important to carefully monitor its use in individuals with a history of manic or hypomanic episodes, as ketamine can induce transient manic-like symptoms.

Postpartum depression: Ketamine-assisted therapy has been explored as a potential treatment for postpartum depression. .

Chronic pain: Ketamine's analgesic properties make it useful in managing chronic pain conditions, such as neuropathic pain, complex regional pain syndrome (CRPS), and fibromyalgia. It can provide pain relief and may also improve mood and quality of life.

Obsessive-compulsive disorder (OCD): Ketamine has demonstrated potential in reducing symptoms of OCD, including intrusive thoughts and compulsive behaviors. It may offer relief for individuals who do not respond to traditional OCD treatments.

Mood disorders, PTSD, and OCD are usually treated with psychotropic medications and/or talk therapy. Other treatment modalities include electroconvulsive therapy (ECT) and Transcranial Magnetic Stimulation (TMS), usually reserved for treatment-resistant-depression.

There are no common long term side effects associated with ketamine treatment. Side effects may occur directly after the administration of ketamine or following a session, and usually resolve within a few hours. This may include: mild nausea, dizziness, derealization, and drowsiness.