Ketamine infusion therapy is the latest treatment approach for depression. A tranquilizer that is often administered as an anesthetic in veterinary medicine, ketamine has a long history as a commonly abused drug, known as Special K.
Recent studies on ketamine and depression have opened the door to ketamine’s potential to address clinical depression. Thus, ketamine treatment centers are popping up nationwide. However, this radical new therapy has some serious side effects, and research on its efficacy is in the early stages.
Moreover, when new treatment modalities arise, children and adolescents are rarely the focus of initial experimentation. Therefore, risks are possible or even probable when using ketamine for teen depression.
Ketamine Infusion Therapy: A New Approach for Depression
According to data from the 2017 National Survey on Drug Use and Health, 13 percent (or 3.2 million) of US teens ages 12 to 17 claim to have had at least one major depressive episode in the past year. Such statistics reveal a dramatic increase from 8 percent (or 2 million) in 2007. Given the dangerous nature of teen depression and resulting suicidality, the American Academy of Pediatrics recommends regular depression screening for all adolescents 12 years old and over. Such screenings are essential since parents, teachers, and even family physicians often miss the symptoms of depression.
Given the extent of the problem, researchers and pharmaceutical companies are working to develop new treatment methodologies for depression. Beyond scientifically validated approaches, such as therapy and antidepressants, more radical options are transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT). ECT, while often considered old-fashioned and even barbaric, is currently the most effective modality for major depression that fails to respond to other treatment.
How Does Ketamine Treat Depression?
Given the severity of clinical depression in teenagers, families of those suffering from severe depressive disorders are asking, “How does ketamine treat depression?”
Research done at Yale shows that the drug triggers glutamate production, which in turn prompts the brain to form new neural connections. As a result, the brain becomes more adaptable. Therefore, patients more easily form new networks, encouraging more positive thoughts and behavior patterns. Some experts believe that these new neural pathways help build resilience and protect against a relapse into depression.
Furthermore, ketamine infusion therapy has ignited interest because of the rapidity of the results. Writing in the Harvard Health Blog, Dr. Robert C. Meisner notes in a recent post, “If a person responds to ketamine, it can rapidly reduce suicidality (life-threatening thoughts and acts) and relieve other serious symptoms of depression. Ketamine also can be effective for treating depression combined with anxiety.”
Two Types of Ketamine Treatment
Currently, two types of ketamine are used to address treatment-resistant depression. They are as follows:
- Given as an infusion into the bloodstream, racemic ketamine is sometimes referred to as intravenous, or IV, ketamine. A mixture of two mirror-image molecules, “R” and “S” ketamine, it is approved as an anesthetic by the FDA. Today, ketamine infusion therapy is used off-label to treat depression.
- Approved by the FDA in March of 2019, esketamine is given as a nasal spray, sold under the brand name Spravato™. Only using the “S” molecule, it is less frequently used in terms of research or applications as ketamine infusion therapy. The nasal spray is only available at certified doctor’s offices or clinics.
Side Effects of Ketamine for Depression
Given the newness of ketamine infusion therapy, the medical community does not yet have a full picture of how well ketamine for depression works. Although some people seem to respond well, others respond poorly and even deteriorate.
As a party drug abused at clubs and raves, the side effects of street ketamine are more understood. However, these side effects may be affected by the possibility of contamination that comes with any street drug, in addition to the lack of medical supervision.
The possible side effects of ketamine administered through ketamine infusion therapy include the following:
- Nausea and vomiting
- Swollen eyelids, face, lips, or tongue
- Hives and rashes that itch intensely
- Irregular heartbeat, either too fast or too slow
- High blood pressure, chest pain, and shortness of breath
- Disturbances of perception, like blurred vision and intense colors
- Dissociation or out-of-body experiences
- Confusion and paranoia.
Promising Research on Ketamine for Depression Side Effects
While some research has been done on ketamine interventions for adults with treatment-resistant depression, few studies have examined the impact on adolescent depression. A 2018 study published in the Journal of Child and Adolescent Psychopharmacology looked at the effects of IV ketamine on 13 participants, aged 14 to 18.
Using the Children’s Depression Rating Scale (CDRS), researchers from the Mayo Clinic and the University of Minnesota measured depression symptoms before and after administering six ketamine injections over a two-week period. On average, the study participants showed a 42.5 percent decrease in CDRS scores. Moreover, five of the teens in the study met the criteria for remission. Subsequently, three of those five remained in remission six weeks later, while the other two relapsed.
While the researchers were optimistic about the drug’s potential, the published study concluded on a note of caution: “Questions remain regarding the long-term safety of ketamine as a depression treatment; more information is needed before broader clinical use.”
J Child and Adolescent Psychopharm. 28(7).