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Esketamine and Ketamine: The Controversial Treatment Transforming Mental Health

Ketamine therapy has been making waves in the field of mental health treatment in recent years. It offers a new perspective on managing various psychiatric conditions and has shown remarkable efficacy in providing relief where conventional treatments have often fallen short. In this comprehensive article, we will delve into the world of ketamine therapy, exploring what ketamine and esketamine are, their efficacy in treating different conditions, the treatment process, the controversy surrounding this therapy, its mechanism of action in the brain, and why it should always be accompanied by counseling from a licensed professional.

What is Ketamine?

Ketamine, originally developed as an anesthetic, is a dissociative anesthetic and a schedule III controlled substance in the United States. It is known for its ability to induce a trance-like state of consciousness, which makes it invaluable in surgical and emergency medical settings. However, it has also gained attention for its potential in the treatment of various mental health conditions.

Ketamine acts as an NMDA receptor antagonist in the brain, leading to altered perceptions of reality, dissociation, and analgesia. It is available in several forms, including a liquid solution for intravenous (IV) use, powder for intranasal administration, and compounded topical creams.

Esketamine: A Breakthrough in Depression Treatment

Esketamine, a derivative of ketamine, is an FDA-approved medication specifically for treatment-resistant depression (TRD). It is administered intranasally under medical supervision. Esketamine represents a significant advancement in psychiatric treatment, particularly for individuals who have not responded to conventional therapies like antidepressants or psychotherapy.

Efficacy in Treating Various Conditions

Ketamine and esketamine have demonstrated remarkable efficacy in treating a range of psychiatric conditions, including:

a. Treatment-Resistant Depression (TRD): Esketamine has been a game-changer for individuals who do not respond to traditional antidepressants. Studies have shown rapid improvement in depressive symptoms, often within hours or days.

b. Post-Traumatic Stress Disorder (PTSD): Ketamine therapy has shown promise in alleviating the debilitating symptoms of PTSD, providing relief from intrusive thoughts, nightmares, and emotional numbness.

c. Bipolar Depression: Ketamine has exhibited effectiveness in both the depressive and manic phases of bipolar disorder, offering an alternative to traditional mood stabilizers.

d. Obsessive-Compulsive Disorder (OCD): Ketamine therapy has demonstrated potential in reducing the severity of OCD symptoms, allowing patients to regain control over their compulsions and obsessions.

e. Chronic Pain: Ketamine, when used as a pain management adjunct, can provide relief from chronic pain conditions like complex regional pain syndrome (CRPS) and neuropathic pain.

The Ketamine Therapy Process

Ketamine therapy involves several key steps:

a. Screening: Patients are carefully assessed to determine if they are suitable candidates for ketamine therapy. Factors such as medical history, psychiatric history, and current medications are considered.

b. Administration: Ketamine or esketamine is administered in a controlled medical setting. The choice of administration method (IV, intranasal, or other) depends on the patient’s condition and treatment plan.

c. Monitoring: Patients are closely monitored during and after ketamine administration to ensure safety and comfort.

d. Follow-Up: Regular follow-up sessions with a licensed healthcare provider are essential to track progress and adjust treatment as needed.

e. Integration: Ketamine therapy should always be integrated with counseling or psychotherapy to maximize its long-term benefits.

The Controversy Surrounding Ketamine Therapy

Ketamine therapy is not without controversy. Several key concerns have arisen:

a. Abuse Potential: Ketamine is a controlled substance and has the potential for misuse. Ensuring proper screening and monitoring is essential to mitigate this risk.

b. Lack of Long-Term Data: While the short-term benefits of ketamine therapy are well-documented, the long-term effects and safety profile are still being studied.

c. Cost: Ketamine therapy can be expensive, potentially limiting access for some individuals.

d. Ethical Concerns: Some critics argue that the rapid effects of ketamine may lead to over-reliance on the drug rather than addressing underlying psychological issues.

Ketamine: Mechanism of Action in the Brain

Understanding how ketamine works in the brain is crucial to appreciating its therapeutic potential. Ketamine primarily targets the glutamate system in the brain, particularly the NMDA receptors. It increases the release of glutamate and subsequently activates other receptors, leading to the formation of new neural connections and synaptic plasticity.

Additionally, ketamine can have a profound impact on mood-regulating brain circuits, such as the default mode network (DMN). It temporarily disrupts the DMN, which is often overactive in conditions like depression, allowing individuals to experience a break from ruminative and negative thought patterns.

Physician Training and Licensing

Physicians who provide ketamine therapy must meet specific requirements, including:

a. Proper Medical Licensing: Ketamine therapy must be administered by licensed medical professionals, such as psychiatrists or anesthesiologists, who have the necessary qualifications and credentials.

b. Specialized Training: These healthcare providers should undergo specialized training in ketamine therapy to ensure safe and effective administration.

c. Compliance with Regulations: Physicians must adhere to state and federal regulations regarding the use and prescription of controlled substances like ketamine.

The Importance of Counseling with Ketamine Treatment

Ketamine therapy is not a standalone treatment. It should always be undertaken in conjunction with counseling or psychotherapy provided by a licensed mental health professional. Here’s why this combination is crucial:

a. Addressing Root Causes: Ketamine may provide rapid relief from symptoms, but counseling helps patients explore and address the underlying psychological and emotional issues contributing to their condition.

b. Long-Term Benefits: Counseling provides patients with the tools and strategies needed to maintain mental wellness and prevent relapse.

c. Holistic Approach: Combining ketamine therapy with counseling offers a holistic approach to mental health treatment, addressing both the neurobiological and psychological aspects of mental disorders.

Wrap Up

Ketamine therapy, including the use of esketamine, represents a promising frontier in mental health treatment. It has shown remarkable efficacy in treating conditions such as TRD, PTSD, bipolar depression, OCD, and chronic pain. However, it is not without controversy, and proper patient screening, monitoring, and counseling are essential components of responsible treatment. As research into ketamine’s long-term effects continues, it is clear that this therapy has the potential to transform the lives of individuals struggling with severe mental health challenges when administered by trained professionals in a comprehensive treatment plan.


Ketamine and Depression: Know the Reality, Myth, and Controversy

Ketamine has a long history of wearing many hats. Initially, the military used it as an anesthetic. Today, ketamine and depression are getting a lot of attention because of how quickly the drug works.

The most significant benefit, according to some, is that ketamine could help to prevent depressed individuals from harming themselves.

Unfortunately, there is some controversy surrounding ketamine and depression because of the drug itself. Ketamine is sometimes shuffled into the category of synthetic and designer drugs.

As a street drug, it has names like Special K, Vitamin K, or jet. It can be highly addictive when taken incorrectly. Therefore, it’s essential to separate the truth from reality when it comes to this drug.

What Does Ketamine Do?

When it comes to ketamine and depression, the drug works by giving users a sense of dissociation. Some describe the symptoms as a less-intense version of PCP. Extremely low doses are given for depression, meant to manage symptoms rather than offer a feeling of “getting high.”

That’s why people who use ketamine for depression go for a limited amount of infusion treatments only. The procedures are monitored, and the correct dosage is given. Patients safely wean off the drug after about eight sessions.

When it’s taken in pill or capsule form, and the incorrect dosage is given, ketamine can cause harmful symptoms like:

  • Confusion
  • Drowsiness
  • Increase in blood pressure
  • Nausea
  • Visual disturbances

More severe side effects can include difficulty speaking or slowed breathing. Often, people who abuse ketamine show signs of irritability and have changes in their mood. Also, they are often disoriented or have difficulty remembering things.

Is Ketamine a Good Thing?

So, can ketamine and depression work together? Or, should you worry about the “street drug” aspect of it?

While misusing ketamine can lead to dependence and withdrawal, medical professionals often use it to treat depression. It’s never something that you should start taking on your own without the guidance of a medical professional.

If you do start taking it in capsule form, it’s more likely that you’ll become dependent on the drug. That can quickly lead to addiction and, eventually, without it – withdrawal. Withdrawal symptoms from ketamine include an increase in depression as well as anxiety, anger, and even restlessness. In the long run, taking it improperly can make your depression worse.

People who experience depression can quickly turn to things like drugs or alcohol to cope with the symptoms. So, the euphoric-like side effects that ketamine can provide are often appealing to those who have feelings of extreme sadness. But, it’s never a good idea to use a substance as a way to deal with depression.

Controlling the Controversy

One of the best ways to manage your depressive symptoms is to talk with your doctor or a therapist. If you’re having thoughts of self-harm or suicide, don’t take it lightly. Call 911, go to your nearest ER; get help immediately. It’s best to speak with someone who is able to help and support you.

While different types of anti-depressants and other drugs work to manage your symptoms, controlled environments and dosages are critical.

If you have an interest in ketamine as more than just a street drug, infusion treatments can help. A physician will space out infusions over several sessions. And, help you come off the drug carefully, so it doesn’t become addictive, and your system doesn’t go through withdrawals.

It’s understandable to want to find relief from your depressive symptoms immediately. But, don’t risk your overall health and wellbeing to do it.

If you want to learn more about ketamine and depression, or you want to talk about your symptoms, feel free to contact me or set up an appointment. Or, if you are struggling with addiction, visit my page on synthetic and designer drugs to learn more about how I can help.