State of the art treatment for depression, PTSD, anxiety, and addictions
What is Ketamine?
Ketamine is a general anesthetic developed in the early 1960s to debut in 1970. It is rated a Schedule 3 drug, which is one level of restriction less than opiates. It is one of the most widely used drugs in modern medicine, and is on the World Health Organization’s List of Essential Medicines. Beyond its use as a general anesthetic, it has a variety of medical roles but most are off-label, meaning that the use is not officially accepted by the medical or legal community, or recognized by insurance companies when reimbursing claims.
Ketamine has a remarkably safe track record in surgical settings, in the emergency room where it is used both for general anesthesia as well as for minor procedures, in pain clinics for CRPS and phantom limb syndromes and now, most recently, it has been found to be unique in its ability to profoundly address major depression, anxiety, and PTSD. Its role in the emergency room, where it is commonly used to induce a significant level of anesthesia for such minor procedures as laceration repair, is special testimony to the drug's safety; if one child in the ER went bad from ketamine, the drug would never be used again.
Ketamine is also used by the US military with virtually every dose of morphine for the purpose of decreasing our use of the much more dangerous opiate. It is also used in veterinary medicine in much the same roles for which it is used humans; on that note I would predict that it would even have use for depression or PTSD diagnosed in animals.
Approximately a decade ago ketamine was discovered to be remarkably effective as an anti-depressant which is in contrast to our most commonly used antidepressants, the SSRI's, for which there is no scientific evidence that they treat depression, anxiety, or PTSD with any more effectiveness than a sugar pill. This fact is especially significant considering that Big Pharma is making more than $10 billion a year from their SSRIs which mandates that their fellow Americans continue to suffer diseases which are arguably among the most painful and debilitating diseases known to man and which together currently afflict more than 70 million citizens.
Note that this situation defines itself as a national security issue. If we could take those 70 million compromised citizens and make them whole again... if we could take this quarter of our population off the sick list and make them productive citizens again... Eli Lilly, the rest of Big Pharma, and maybe a few psychiatrists might hurt a little, but the country and all of the rest of us in it would hugely benefit and be exponentially happier and more productive for it.
Please see my referenced paper on this topic available on this site and entitled, "The Happiness Scale." It is a portrait of predatory Big Pharma feeding on its fellow citizens while collecting a fee. The purpose of the article, however, is not so much to point a finger at the offending capitalists as it is to direct our attention to places where it may have healing results.
Another observation provides a recent major insight on ketamine's effectiveness. Ketamine works as a vaccine to actually prevent depression, anxiety or PTSD. We saw this first during a major aircraft carrier fire where 80 sailors suffered 3rd degree burns and half of them by chance were given ketamine; that ketamine half had a much lower incidence of PTSD. And that effect has been duplicated, suggesting that motor vehicle accidents, rape, assault, even divorce might benefit from "ketamine foresight."
The US military has used ketamine as a battlefield anesthetic since the Vietnam War where it was for the first time used safely to induce general anesthesia in the field. No other medicine can safely put a patient down while protecting her airway, a unique ability among all general anesthetics which suppress breathing as was the unfortunate outcome with Michael Jackson.
"The most dangerous thing about ketamine is going to the bathroom." This is a point I make often, underlining that ketamine has very few negative physiologic effects. You will be somewhat "drunken" on ketamine; after all, we can take out your appendix painlessly with a little more drug. Of course you will be unstable on your feet; but there is very little else that it does to your body. In abusers taking the drug in large amounts over long periods of time there are bladder syndromes and occasionally liver irritations, but otherwise ketamine seems to be a very safe drug. Longterm use, though, needs study.
As mentioned, ketamine can be abused recreationally though the drug itself has no "withdrawal" syndrome in the same sense as opiates. Ketamine’s use outside of that of an anesthetic is considered “off label” and, as with all off label medicines, is allowed when deemed medically appropriate by an attending physician. For perspective, note that estimates suggest that almost ¼ of all prescription medications sold in the United States are prescribed with off label intention.
How Does Ketamine Work?
Ketamine has many mechanisms of action and the anesthetic properties for which it was developed have been shown to be very different from the antidepressant effects which derive from only partially understood pathways that are currently undergoing new and intense scrutiny. NMDA receptors account for the psychedelic and anesthetic effects while the antidepressant component is associated with other pathways, AMPA and mTOR being the two mentioned most commonly and targeted most often for future study.
New drugs based on ketamine and these other pathways are being studied as they are being sought. Currently there are a number of medicines being developed from the early products of metabolis, so-called esketamine and arketamine, where the pharmacies are each touting a different product as likely to provide relief from depression while the other sister product flounders. Moneyed hopes, of course, accompany each pharmacy's product as both pharmacies continue to bad-mouth out-of-patent ketamine from moneyed motives.
How Soon Will I Notice Improvement?
Many patients feel better during the treatment itself. Others notice a marked improvement in mood or pain levels within a day of treatment. This is in marked contrast to other antidepressants which may take months to see effects and be properly evaluated. This early response that is predictive of future outcome is unique in the world of depression and is, I think, valuable; it is not far-fetched to assert that this early indicator can save lives purely from the optimism that it affords minds that have been so sorely without it for the expanses of time that only extremes of despair may know.
This is not to be confused with the mere "high" of recreational drugs. After all, methamphetamine will clear the ache of depression by assaulting your dopamine pleasure centers, but the next day will see a severely magnified depression in that same brain; give ketamine instead and that next day has the potential of restoring a normalcy that might have been absent since a long-ago childhood.
This predictive ability of ketamine I refer to as a "natural candle" after the astronomy term that alludes to Cepheid variables as stars that have a known level of fixed brightness that allows astronomers to measure the distances to objects that have these natural candles in them. So, where a natural candle lets us measure galactic distances, ketamine lets us predict a healthy outcome for minds suffering from anxiety, depression, or PTSD.