An estimated 322 million people worldwide suffer from depression. That’s a huge chunk of the population. For those that suffer with depression, it can be a bleak experience; you often feel hopeless and as if the cycle will never end. Even if you do get a prescription to help your brain out, it isn’t guaranteed to work and you’ll have to wait weeks just to see if you’ll have any results.
For those that don’t live with depression, it can be difficult to understand why new antidepressants are hitting the market. Like when you have a bacterial infection, your doctor will prescribe you a “one size fits all” antibiotic. So why isn’t the same done for those with depression? Or are they just manufacturing bigger, badder medications like they do with antibiotics? As hinted above, not every antidepressant out there will work for every single person. Everyone’s brain is wired different. Plus, it takes weeks just to know whether or not your prescription is going to work.
That’s where ketamine is supposed to step in and set itself apart from the crowd. But before we talk about ketamine, let’s talk a little about depression and antidepressants to give you a better understanding of what 322 million people deal with everyday.
Not all medication is created equal
You probably recall hearing about the suicides of Anthony Bourdain, Kate Spade, Chester Bennington and more. You probably felt shocked and if you’re neuro-typical (meaning you don’t have any mental illnesses) then you probably couldn’t understand why they did it. They’re extremely wealthy and have access to all of the best medications, doctors, and therapies money can buy. So why did they do it?
According to studies, one-quarter of the 16 million Americans who suffer from depression get little to no benefits from treatments. This applies to both antidepressant drugs and talk therapy. That’s a staggering portion of the population! And that’s not even including those who have adverse reactions to their medications.
With so many antidepressants on the market, you would expect them to find something that works. However, it can get incredibly frustrating for both patient and doctor when nothing seems to work. At this point many patients simply give up and opt to live with their depression, which of course can lead to suicide. For others who stick it out, they can try for 17+ years (speaking personally) before finding something that works.
And for those that have adverse reactions to their medicine (suicidal thoughts, fantasies of self-harm, etc.) these can be detrimental to someone who is already suffering from depression. And unfortunately, doctors really don’t have a way to predict what medications will and won’t give you those side effects; it’s a roll of the dice.
Also, what works for some doesn’t work for others. Just because Zoloft has had great effects on one patient, doesn’t mean it won’t give the next suicidal thoughts. Because of this, doctors need a compromise history and most patients downplay their depression. “If I tell the doctor that I have thought of killing myself, I’m off to a psych ward for a 24 hour observation period.” Unfortunately, this doesn’t help because doctors don’t know the extent of your depression and can’t help as accurately. However if a patient is completely honest, it’s still a roll of the dice as to whether or not the drug will help.
Antidepressants take time
Another leading factor behind suicide is the fact that drugs take time to get into your system. On average, a patient must wait 4-6 weeks to see if the medicine works for them. After 4 weeks, those closest to the patient will start to see results while it takes 6+ weeks for the patient to see results themselves. During this time, the patient might also feel worn out, sleep a lot, notice changes in their behavior, insomnia, moving through a “fog”, and other unpleasant side effects.
This means that not only is each prescription a roll of the dice, but you must wait around 4-6 weeks to even know if it’s going to work or not. Assuming you don’t have adverse effects right out of the gate, you may stay on the medication for the full duration only to find that it doesn’t help at all. This is also when patients are at high risk for suicide; realizing that the medication prescribed isn’t working only feeds deeper into the “you’ll always feel this way” mentality.
But until now, there hasn’t been an antidepressant that offers quick relief. For those suffering from anxiety, hydroxyzine can provide relief from your symptoms in as little as 15 minutes. While it won’t completely take away the anxiety for some, it will lessen the effects and you’ll be able to breathe again.
This is where ketamine shines: it promises to work similarly to hydroxyzine and provide near instant relief. However, we’ll dive a little deeper into that later; right now, let’s talk about what ketamine is.
What is Ketamine?
Ketamine has been around for a while but its original use was as a general anesthetic. It was used primarily for both starting as well as maintaining anesthesia. It offers not only pain relief, but mild sedation. Patients that are given ketamine enter a trance-like state where the pain “feels far away”. Like many heavy anesthetics, it also has memory loss as a side effect. In other words, you won’t remember your pain or the surgery.
Ketamine is also used for people suffering from chronic pain. The drug is injected either via IV or directly into the muscle in order to offer relief from the pain. Of course, the drug is definitely “toned down” so to speak, so you’ll get relief from your pain without slipping into that trance-like state you enter right before they cart you into surgery.
The drug is also used for sedation and to calm down as well as relax antsy patients. Many doctors give a small amount to children in order to keep them calm before surgery and the same applies to adult patients. While it’s not the primary go-to method (many will offer an Ativan or some other diazepam to calm a patient down), many doctors swear by its effects.
Originally derived from PCP, ketamine was at one point in time a club drug or considered to be a horse tranquilizer that people took for fun. At the time, it was referred to as Special K. How being tranqed out of your mind is fun, we’ll never know but as always no judgments if that’s your thing.
How does it work?
Ketamine works by blocking the NMDA receptor, which normally activates neurons within the brain. When this receptor is messed with, the central nervous system begins to stop responding. With lower doses, patients may experience a state of hypnosis, instant pain relief, and sights and sounds will appear wonky. Many describe it as feeling “far away from everything”.
For moderate doses, people feel as if they’re being separated from the environment or themselves. Mild paralysis can also occur and is referred to as the “K-hole.” If dosage is upped, almost complete paralysis, memory loss, and sedation will occur. However, unlike many other sedatives, your respiratory system will continue to function.
Traditional sedatives were a mixture of cocktails that put patients not only completely under, but shut down their respiratory system. Machine and tubes manually “breathe” the body for the patient during the surgery and until the drugs wear off. Of course there are always risks involved with this, which is why ketamine has quickly become a go-to for many doctors.
Ketamine as an antidepressant
Ketamine markets itself as a fast-acting depression drug that is FDA approved and hopes to help millions of people suffering from depression. The nasal spray version of the ketamine drug has shown promise in studies as an effective antidepressant. The FDA approved the drug on Tuesday as a means of helping people with depression. Studies have also shown that many people who are resistant to drugs will benefit from the antidepressant.
Many doctors hope that this drug will move us out of the Prozac era. The ketamine treatment, which is being called esketamine, was created by Janssen Pharmaceuticals Inc. This company is a branch of Johnson & Johnson and intends to market the spray under the name Spravato.
Putting into a nasal spray was priority one for the company; injections require trips to the doctor and the company was worried that many patients would simply not go. After all, routine doctor trips aren’t always in the cards for those suffering from depression and anxiety. Since it’s something that can be taken at home, there is a lot less pressure on the patient to go to the doctor while still finding relief from their depression.
The spray also contains a portion of the ketamine molecule that remains active. However, don’t expect to feel the full paralysis effects of the ketamine. Since it’s such a low amount of the ketamine, patients might feel wonky or as if they’re moving through a fog. Over time, the side effects will be less prevalent as your body adjusts to the medication but the effects on your depression will remain the same.
The anesthetic is already available for depression at clinics all around the country through a series of intravenous treatments. However, you’ll have to wait a little longer for the spray version to hit the market.
How does Ketamine work for depression?
Given the information above, you might be wondering how ketamine works for depression. Unfortunately, the antidepressant aspect of this drug isn’t well known right now. Why it works for depression is a bit of a mystery. Just like hydroxyzine that was created originally as antihistamine, it also doubles as an anxiety relief. Why it works that way is unclear, but that doesn’t change the fact that many doctors and patients are happy that it does.
However, what we can tell you is that it provides near instant relief. Many patients reported feeling better within about 20 minutes of taking the spray while others said it took around an hour. Either way, that’s incredibly fast! As stated above, most antidepressants take a solid 4-6 weeks to get into your system and for you to see results. This means that in 4-6 weeks, you’ll see less of the dizzy side effects of the medication without having to wait to see if it works for you and your depression.
How often do you take it and what’s the cost?
The spray is take twice a week for four weeks with an oral antidepressant. Your first dose will be taken in the doctor’s office where you will be monitored for two hours to insure that you don’t have any adverse reactions to the medication. You will also be asked to not operate any heavy machinery or drive for the rest of the day so expect to take an Uber home or get a ride from a friend.
Esketamine also has a high risk for abuse just like its predecessor esketamine due to the fact that it is derived from PCP; a highly addictive street drug. Esketamine can also cause psychotic episodes in people. This mostly applies to those who are already at high risk for the episodes, but it can happen to others who have never experienced it before. This is why your doctor will ask you to stay after the first dosage and to remain in constant contact for a few weeks.
The cost of the drug is where a lot of people will also feel turned off. The cost for a month’s worth of treatment will vary between $4,720 and $6,785. While we’re sure that a generic version of the drug will be available at a better price at some point, the initial cost is staggering. Currently, no insurance plans cover the drug; it’s all out of pocket for now. However in the future, many insurance plans will likely cover it.
Do you think this is the fix-all drug that depression sufferers have been waiting for? Or do you feel like some of the skeptics that this is proverbially Lucy with the football and Charlie Brown desperately running to kick it only to have it pulled out from under him at the last moment? Let us know in the comments below! And if you feel up to sharing, let us know your personal experiences with depression whether you or a loved one suffer from it.