TMS Ketamine
How effective is Ketamine for depression?
For individuals facing the challenges of depression, including severe and treatment-resistant cases, research highlights the remarkable efficacy of Ketamine infusions, showing a notable 70% effectiveness in significantly reducing depressive symptoms. Notably, these studies deliberately exclude patients utilizing other treatments like medication or psychotherapy, aiming to evaluate the standalone impact of Ketamine treatment accurately. However, a holistic approach combining various treatments is often adopted in practical settings to achieve the best results. Many of our patients undergo a comprehensive strategy that includes antidepressant medication, therapy, and transcranial magnetic stimulation (TMS), leading to substantial symptom reduction in 80-90% of cases.
The response timeline varies, with approximately 50% of patients gauging the effectiveness of Ketamine after the initial infusion. Another 20% experienced positive responses following the second infusion, while an additional 10% observed improvements after the third infusion. Suppose a patient fails to witness improvement after the third session. In that case, we advise against continuing the treatment, as the likelihood of a positive response diminishes significantly after four or more infusions. It’s crucial to note that individuals who have grappled with depression for extended periods may find it challenging to perceive positive changes personally. Friends and family are often better positioned to identify these transformations before individuals recognize them.
How effective is Ketamine for Anxiety?
Dr. Prakash Masand, MD, the co-founder, chairman, and CEO of Centers of Psychiatric Excellence (COPE), and an adjunct professor at the Academic Medicine Education Institute, the Duke-National University of Singapore Medical School (Duke-NUS), emphasizes the significant role of Ketamine in treating anxiety disorders (source: COPE Psychiatry). The conventional approach to anxiety involves the use of traditional antidepressants and additional medications like antihistamines, beta-blockers, and benzodiazepines. However, these supplementary medications can induce sedation, and benzodiazepines may negatively impact memory and cognition. Notably, 30% to 40% of patients may not achieve remission despite trying three or four different traditional medications and evidence-based nonpharmacologic therapies such as cognitive behavioral therapy (CBT) or mentalization-based therapy (MBT) (source: Psychiatry Advisor).
In contrast, Ketamine infusions have emerged as a swiftly effective treatment option for various anxiety disorders, including generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), social anxiety disorder (SAD), and post-traumatic stress disorder (PTSD). Unlike most anxiety medications that primarily target the histamine and monoamine systems in the brain, Ketamine’s NMDA-receptor antagonism is associated with the potentiation of glutamate transmission and an increase in brain-derived neurotrophic factor (BDNF) levels. These mechanisms contribute to its antidepressant and anxiolytic properties. Ketamine stimulates cell growth in the brain and promotes neuronal growth and connectivity, fostering neuroplasticity and delivering a rapid anxiolytic effect.
How effective is Ketamine for PTSD?
Posttraumatic stress disorder (PTSD) arises as a prolonged stress reaction triggered by exposure to a traumatic event, revealing itself through persistent reexperiencing (nightmares/flashbacks), heightened arousal (hypervigilance, increased startle response), and avoidance of thoughts and reminders associated with the event. Prolonged exposure to stress takes a toll on the neurological system, resulting in neural atrophy and diminished synaptic connectivity within the cortical and limbic circuits of the brain—essential for regulating mood, behavior, and cognition. Conventional medications commonly employed to address PTSD, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and alpha agonists/antagonists, frequently yield substantial nonresponse rates, allowing residual symptoms to persist.
Recent evidence suggests that PTSD can be viewed as a “synaptic disconnection syndrome,” and Ketamine emerges as a rapid-acting treatment capable of restoring and enhancing synaptic connectivity in the brain. Ketamine improves signaling quality through glutamate synapses by increasing the availability of glutamate and brain-derived neurotrophic factor (BDNF), facilitating dendritic growth and synaptic connectivity [1]. This heightened signaling works to counteract the adverse effects of chronic stress on both the brain and the body.
What is the frequency and duration of treatment?
The typical treatment protocol entails an initial series of six infusions, with subsequent maintenance infusions administered as necessary every one to three months until a sustained long-term remission is achieved. The dosage of ketamine and the rate of the intravenous (IV) drip are individualized based on factors such as the patient’s weight, medical conditions, and response to treatment. Generally, the infusion process lasts 40-60 minutes, followed by an additional 20-30 minutes for the patient to recover.
How effective is Ketamine for Obsessive Compulsive Disorder (OCD)?
A growing body of evidence points to the involvement of glutamate imbalances in OCD, presenting a promising avenue for innovative therapies. The rapid antidepressant effects of Ketamine suggest the potential for similar anti-obsessional effects, considering the frequent co-occurrence of these disorders and their shared association with glutamate irregularities.
The quick relief of symptoms observed with ketamine stands in sharp contrast to the delayed response seen with current first-line treatments for OCD. Patients undergoing existing therapies may have to wait six to 10 weeks before experiencing clinically meaningful improvement, with their symptom reduction reaching only 40% to 60%, as highlighted by lead author Carolyn Rodriguez, MD, PhD, Assistant Professor at Columbia University in New York.
Source – https://www.semanticscholar.org/paper/Rapid-resolution-of-obsessions-after-an-infusion-of-Rodriguez-Kegeles
Frequently Asked Questions
Treatment Frequency and Duration?
The treatment plan typically commences with an initial set of six infusions, followed by ongoing maintenance infusions spaced every one to three months until sustained long-term remission is achieved. The determination of ketamine dosage and IV drip rate takes into account factors such as the patient’s weight, medical conditions, and response to treatment. The infusion itself usually lasts 40-60 minutes, with an additional 20-30 minutes allotted for recovery.
Onset of results?
In contrast to many psychiatric treatments requiring 4-6 weeks for improvement, some individuals may find relief within an hour of their initial Ketamine treatment, while the majority witness results within a day.
Duration of Effectiveness?
The impact of a single infusion can extend from several days to a few weeks, offering relief during the acute phase and preventing adverse outcomes. A series of six or more infusions delivered over 2-4 weeks builds on each other, fostering more enduring effects over several months. Maintenance infusions every 1-3 months contribute to sustaining the benefits.
Number of Infusions Required?
Optimal results often stem from a series of six infusions followed by ongoing maintenance treatments every 1 to 3 months. The frequency adjusts gradually based on the patient’s response and the duration of the ketamine effect. The total number and timing of treatments vary based on individual needs.
What are the age considerations for Ketamine Treatments?
There is no rigid age limit for Ketamine treatments. Dr. Friday, a Board-Certified Psychiatrist and Child and Adolescent Psychiatrist, recognizes that depression affects individuals of all ages. Treatment decisions are individualized.
Are there any medication restrictions for Ketamine Treatments?
While Ketamine is generally considered safe, it’s essential to communicate all medications being taken. Specific considerations include:
-Lamictal (Lamotrigine): Allow a 6-hour gap between Lamictal and the infusion start and wait 6 hours post-infusion before resuming Lamictal.
-Benzodiazepines (Xanax, Ativan, Valium, Klonopin, etc.): While generally safe during infusion, patients may be advised to skip a dose 12 hours before the infusion and resume 6 hours after.
-SSRI and tricyclics: No need to discontinue these medications, as they do not interfere with Ketamine treatment.