Introduction
Treatment-resistant depression is a major depressive disorder that does not respond to at least two adequate trials of traditional antidepressant medications, which often leads to sufferers feeling anxious and hopeless about the future. TRD is a prevalent issue in Canada, affecting a significant percentage of people seeking mental health support. This condition often leaves individuals feeling vulnerable and desperately seeking relief from their suffering. In recent years, there’s been a growing interest in alternative treatments and solutions for TRD, particularly with drugs like ketamine, which is known for its fast, effective relief and lasting impact on depressive symptoms.
This page explores the role ketamine plays in TRD, including its effectiveness and safety for those seeking relief and long-term recovery from the condition.
What is treatment-resistant depression?
As mentioned, TRD is a type of major depressive disorder (MDD) that doesn’t respond to at least two adequate trials of standard first-line antidepressants, usually SSRIs or SNRIs, each taken for six to eight weeks at therapeutic dosages.
Although TRD may sound daunting, there are various paths forward, and many people with the condition find the right treatment and support over time. However, it may take time to find the proper treatment solution for you, so patience and an open mind to trying different treatment methods are essential for achieving your desired outcomes and recovery goals.
TRD can have a significant impact on an individual’s quality of life, affecting their daily functioning, relationships, sense of self, and work. Traditional treatments such as psychotherapy or medications are often ineffective or slow-acting, leaving individuals without feasible options or a way to move forward.
Who is affected by TRD?
What is Ketamine?
Medical professionals originally approved ketamine as an anaesthetic. However, in recent years, it has become a pioneering off-label treatment for TRD.
It is available in two forms:
IV ketamine
IV ketamine, when administered in controlled, low doses, offers much hope to those with TRD. It provides fast-acting relief from the symptoms of treatment-resistant depression, often within hours.
This relief can last for several days or even weeks, leading to a significant improvement in an individual’s condition and instilling a profound sense of hope and optimism.
A typical treatment plan, designed to ensure the individual’s comfort and safety, usually begins with two sessions per week for two to three weeks.
This personalized approach ensures that the person’s response to the treatment is closely monitored and adjusted as necessary, providing reassurance and clarity on what to expect.
It then gradually tapers to weekly, biweekly, and eventually monthly infusions.
Clinical studies report response rates of up to 70% in individuals who receive regular IV ketamine treatments.
Esketamine
Esketamine, a derivative of ketamine branded as Spravato, was approved by the FDA in 2019 specifically for the treatment of TRD.
Administered as a nasal spray in a clinical setting, esketamine provides rapid symptom relief, often within hours of administration.
Each session includes a two-hour observation period to monitor for side effects. Standard treatment involves twice-weekly dosing for four weeks, followed by a weekly schedule, then
tapering off as symptoms improve.
Although not a cure, both ketamine and esketamine represent significant advancements in depression care. Their safety and effectiveness have been demonstrated in numerous studies, providing reassurance for those considering these treatments.
Unlike traditional antidepressants, which may take several weeks to become effective, these therapies provide rapid-acting options for individuals who haven’t responded to other medications.
Esketamine, in particular, has the potential to change the way depression is treated, offering fresh hope for those who have not responded to other treatment methods.
Both IV and oral ketamine treatments target the brain in unique ways.
Understanding these mechanisms can provide a comprehensive understanding of how these treatments work and their potential to improve mood, alleviate symptoms of TRD, and restore neuroplasticity.
How Ketamine works for depression
Ketamine, which acts as an NMDA receptor antagonist, significantly influences glutamate pathways to help enhance synaptic connections in the brain.
As mentioned, it offers significant, fast relief from the symptoms of TRD, usually within hours, compared to the weeks or months often needed for typical antidepressants to take effect, making it a highly effective treatment for TRD sufferers.
Safety and side effects
What you can expect during Ketamine treatment
Beginning treatment for TRD can feel daunting to many.
Therefore, it can be helpful to know what to expect during sessions. Below is an idea of a typical ketamine treatment plan for those with TRD:
How to know if Ketamine is right for you
Those seeking treatment for TRD must choose a healthcare provider who can ensure safe administration, supervision, and ongoing care and support.
Myths and misconceptions
Due to its high recreational use, it’s not surprising to learn there are various myths and misconceptions surrounding the use of ketamine.
Ketamine represents a promising, viable option for individuals living with conditions like treatment-resistant depression.
With its rapid symptom relief and improved neural function, ketamine’s effectiveness can be enhanced when combined with other approaches, such as a clinical, trauma-informed approach to care, including talk therapy, counselling and mindfulness.