The Therapeutic Effects of Ketamine in Mental Health Disorders: A Narrative Review
Specifically, it is not known to what extent the observed decrease in depression and anxiety severity would have occurred even under placebo conditions. Other includes limited sample size and absence of female sex, and hence, the finding cannot be generalized. Notwithstanding the important limitations, we believe that the current report contributes significantly to the small but growing literature on the clinical impact of ketamine in patients with severe depression. The beneficial effects of the ketamine infusion on pain scores are lost by 12 weeks, which must be set against the chronicity of the disease.
The present investigation summarizes existing knowledge and research surrounding ketamine infusions for CRPS to provide a well-rounded depiction of advantages and disadvantages for physicians who may be considering it for patients with this challenging and complex condition. Here are five reasons why it’s important to work with a trained facilitator during ketamine therapy to maximize its therapeutic effects for lasting and transformational inner change. He completed five combat deployments to Afghanistan between 2004 and 2014, with a total time deployed of 37 months. During all the deployments, he was exposed to dead bodies, explosions, constant danger, and the killing of humans and animals. His career started as an infantryman during his 2004–2005 deployment, and the rest of the time he served in Special Forces. The patient also had significant history of childhood sexual and physical abuse that occurred during 1988–1996 (age 8 to 16) from his stepfather, with over 100 encounters during the eight years of abuse.
Health Conditions
Ketamine’s pharmacological benefits span various medical fields, but its safety profile necessitates careful use. Strict adherence to guidelines is essential to mitigate risks like psychological effects, cardiovascular issues, and dependency. With its growing role in psychiatry, further research should focus on dosing optimization, patient monitoring, and long-term use guidelines.
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Any new reference was reviewed by three investigators and was categorized by the same inclusion/exclusion criteria. If the investigators disagreed on categorization, the fourth investigator (R.E.) was consulted. Migraine is a common primary HA disorder responsible for global morbidity, diminution in the quality of life, and is the second leading cause of disability worldwide 4. Renowned for incapacitating hemi-cranial pain, its clinical evolution from onset to resolution manifests in a phasic array of noxious and varied debilitating neurological symptoms (Table 1) 1. Migraine and other primary HAs are responsible for a significant decrease in work production 5, affecting one in four homes, one in five women, one in sixteen men, and one billion people worldwide 4.
- Functional rehabilitation is at the centre of the care pathway and should be facilitated by education/self-management strategies, psychological and pharmacological support.
- The American Society of Anesthesiologists Classification (ASA Class) system can help identify individuals who require formal anesthesia consultation, particularly those classified as ASA category 3 or above66,69.
- Our experienced medical professionals are here to help you understand how this innovative treatment could provide the lasting relief you’re seeking.
Possible Alternatives to Ketamine Therapy
The American Society of Anesthesiologists Classification (ASA Class) system can help identify individuals who require formal anesthesia consultation, particularly those classified as ASA ketamine infusion therapy: techniques and efficacy category 3 or above66,69. Finally, you have a process by which the patient receives ketamine first and then, usually within a few days, has a session with their psychotherapist. In this instance, the ketamine has enabled the patient to have moments of realization independently and then discuss them with a mental health professional when not under the influence of the medication. All three can be beneficial, though most of the clinical research proving ketamine’s effectiveness for mental health conditions has been conducted with IV infusions of ketamine without psychotherapy at the same time.
These reports (mostly derived from experimental studies) are at best preliminary and large randomized controlled trials in chronic pain patients are required to address these issues. It is of interest to speculate whether ketamine could prevent the occurrence of chronic pain states, such as may occur following surgery. Wilson et al. assessed the effect of ketamine to reduced chronic pain development following lower limb amputation (with a known incidence of persistent pain in up to 80 % of patients) 39.
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In addition, many those with depression do not gain the desired benefit (i.e., decreased depression) after taking anti-depressant medication. One of the most striking features of the ketamine infusion studies is the lack of improvement of mood or function despite the improvement in pain scores. This is surprising given the recent realization that ketamine exerts an antidepressant action 18. It also runs counter to the belief that the functional deficits in CRPS are exclusively secondary to pain. This is more consistent with the idea that the motor disturbance is a separate pathological entity. It is perhaps also relevant that acute ketamine dosing is known to cause ataxia and motor impairment.
Risks of ketamine treatment
Without this integration support, the therapeutic gains from ketamine can be fleeting. The patient started psychotherapy in 1996 and completed EMDR therapy in three months, seeking help with sexual trauma, but this method was extremely painful. The patient had three admittances to psychological wards, for depression, PTSD and TBI. The patient recalls being placed on Prozac and Wellbutrin, however, at the time of KI and CSB injection the patient was medication-free. He had misdiagnosed with bipolar disorder in 2019, for which he took medication for approximately four months before treatment cessation.
Who is not a good candidate for ketamine therapy?
- Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist typically used as an anesthetic and analgesic, presents a promising potential treatment for CRPS in patients who fail to respond to traditional therapies.
- Overall, IV ketamine infusions were well tolerated and deemed safe 2, 38–40, with significant dissociative effects only reported in one case study 40, and other mild, transient dissociative effects reported in all studies 2, 38–40 (Table 2).
- Structured clinical guidelines provide a framework for standardized ketamine use, particularly for TRD, emphasizing the importance of specific dosing protocols tailored to individual patient needs52.
- KAP may be partially covered by insurance, but you should check with your insurance company for specific coverage details.28 Some insurance plans may cover the therapy sessions, but not the ketamine medication itself.
While intranasal (IN) esketamine is approved for treatment-resistant depression (TRD), regulations vary by country. The main molecular mechanism of action of ketamine was uncovered when it was found to be an antagonist at the NMDA class of glutamate receptor 11. The NMDA receptor, then recently identified, was rapidly realized to be a molecular coincidence detector for neurones (fitting with the Hebbian postulate), forming a key player in pathways for synaptic plasticity, learning and memory 12.
In October 2014, our institution began providing ketamine as an off-label therapy for patients not able to participate in research protocols on a case-by-case basis. Here we describe our experience over 30 months providing ketamine as a clinical treatment to participants with severe and treatment-resistant mood disorders. Finally, two retrospective studies by Lauritsen et al. 18 and Pomeroy et al. 27 showed promising results with the use of I.V.
Moreover, most reported adverse events were transient and mild in dissociation 12, 13, 22, 25, 27, 28, 30, 32. Due to its euphoric, dissociative, and hallucinogenic properties, ketamine has been abused as a recreational drug, which has led to rigid regulation of medication. The COVID-19 pandemic has been an unprecedented challenge for the American population which was reflected in increased reports of problems regarding their mental health. Approximately one in ten people stated that they had started or increased substance use because of the COVID-19 pandemic.
