Ketamine

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Is your appetite poor?

Do you put off making decisions?

Are you discouraged about your Future?

Do you have thoughts of ending your life?

Have you lost interest in others?

Are you more irritable than usual?

Are you unable to relax?

Do you fear the worst may happen?

Do you feel nervous?

Do you feel you're losing control?

Are you afraid of dying?

Does your anxiety worsen your pain?

Does your depression worsen your pain?

As any medical student studying for final exams knows, brief increases in stress can benefit the brain, especially memory. On the other hand, brief but intense stress, such as rape or combat and sustained stress such as poverty, an abusive relationship, or chronic pain can trigger persistent changes in brain architecture. The cells in the brain responsible for impulse control and mood control begin to shrink. Like muscles repeatedly exercised, areas of the brain associated with anxiety and fear begin to enlarge. This can result in chronic anxiety and depression.  

In the context of patients with chronic pain, depression is particularly insidious and severe. Depression makes chronic pain worse. Not surprisingly chronic pain can initiate and worsen depression and anxiety. This vicious cycle is difficult to interrupt and treat. Since the 1980's antidepressant drugs have been prescribed based on the theory that depression is caused by an imbalance of certain chemicals in the brain. The antidepressants caused more of the chemical in short supply to accumulate in the brain.  This accumulation theoretically restores the balance of the chemical that is lacking. This in turn should relieve the depression. Unfortunately, even though pharmaceutical companies have researched these compounds for over 50 years and have made billions in sales, the drugs that are supposed to treat this chemical imbalance aren't very effective and are very slow to act. Less than one third of depressed patients respond to any given drug within 3 months. After half a year and multiple antidepressants only about 50% of patients show recovery. One third of patients don't respond to any conventional antidepressant at all. 

Major depression is the leading cause  of disability worldwide. It places one of the heaviest burdens on society. In the US it is estimated that 16 million adults have an episode of major depression each year. At some point in their lifetimes nearly 50 % of American's are affected by depression. Between the years of 1999 and 2016 suicide rates rose dramatically, increasing by more than 30% in 25 states. Suicide now accounts for the death of 40,000 American's each year. This is more than die by murder or traffic fatalities. Since 2005 the suicide rate for United States war veterans has nearly doubled. In the first 6 months of  2012 alone, more members of the US Armed Forces died by suicide than in combat. 

Ketamine triggers a series of events in the brain prompting it to form new connections between nerve cells. The brain is then able to form new pathways, giving patients the opportunity to develop more positive thoughts and new behaviors. With traditional antidepressants this effect was never seen before. John Krystal, M.D., one of the pioneers in the ketamine research at Yale states, "This is a game changer. When most medications, like Valium, go away, you can get rebound anxiety. By contrast, when you take ketamine, it triggers reactions in your brain that enable new nerve connections to regrow. It's the reaction to ketamine, not the presence of ketamine in the body that produces this effect." Dr. Krystal states this is exactly what makes ketamine unique as an antidepressant, calling it the "anti-medication" medication. Even a single dose of this medicine produces prompt and profound benefits, reducing thoughts of suicide and saving lives. Although no standard protocols have been established, repeating the initial infusion several times has prolonged the effect of ketamine allowing subsequent infusions at longer and longer intervals. 

Not only has ketamine been successful in treating anxiety, depression, post-traumatic stress disorder, and bipolar depression, it is also promising in the treatment of chronic pain conditions such as fibromyalgia and Complex Regional Pain Syndrome, CRPS. Both are conditions characterized by numbness, burning, and tingling pain. Ketamine can cause a rise in heart rate and blood pressure and so is not suitable for people with uncontrolled chest pain and hypertension. Ketamine is also not suitable for those with chronic liver disease, glaucoma, or elevated intracranial pressure. Under proper supervision and monitoring, however, ketamine has a great track record of safety and efficacy. Let us know if you would like to learn more.