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People experiencing severe depression with suicidal symptoms may not have to wait weeks for traditional antidepressants to take effect.
A recent review suggests that a single intravenous ketamine infusion can provide rapid relief for some patients.
Originally developed as an anesthetic, ketamine is a medicine that can reduce pain and, in some cases, help treat depression, but it can also be misused as a recreational drug, experts warn.
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Researchers from the University of Connecticut School of Medicine reviewed 26 clinical trials that included more than 1,100 patients. Approximately 626 received ketamine and 540 served as controls who did not take the drug.
Most of the trials included patients with major depressive disorder, but 11.5% included those with bipolar depression and 7.7% included people with both unipolar and bipolar depressive diagnoses.
Compared to a placebo, a single treatment significantly reduced depression in just four hours and dramatically lowered suicidal thoughts within 24 hours, the study found.
Patients reported fewer depressive symptoms after a week and reduced suicidal thoughts for up to a month after one ketamine infusion. Those who received repeated ketamine infusions showed a similar reduction of suicidal and depressive symptoms at the end of the treatment.
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The most common adverse events of ketamine – including headaches, numbness, dissociation (“out of body” experiences), nausea, dizziness and visual disturbances – were temporary and resolved within hours of the infusion.
Rarer, more serious side events included hospitalization, suicide attempts and suicide, but most were unrelated to ketamine, the review stated.
The analysis was published in May in JAMA Psychiatry.
Treatment-resistant depression
Major depressive disorder is a formal psychiatric diagnosis affecting approximately 280 million people globally, according to recent research.
Effective treatment involves a combination of therapy and medication, frequently antidepressants. However, for a small number of patients, symptoms do not respond to multiple therapies, a condition known as treatment-resistant depression, doctors say.
“When all existing treatment options fail, patients with severe depression could consider ketamine infusions.”
These patients are at a higher risk of very serious, sometimes tragic consequences, including suicidal thoughts, suicide attempts and death.
“When all existing treatment options fail, patients with severe depression could consider ketamine infusions,” lead author Taeho Greg Rhee, PhD, of the University of Connecticut School of Medicine, told Fox News Digital. “This is still a safer option when compared to electroconvulsive therapy (ECT).”
Traditional antidepressants stabilize mood by slowly elevating serotonin levels in the brain, but it can take weeks for the full effect to be achieved.
Ketamine, in contrast, works rapidly by blocking glutamate, a neurotransmitter that can impact emotions negatively when levels are too high in the brain, according to Cleveland Clinic.
Implications for care
The authors say their findings have two important potential clinical applications.
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First, ketamine’s rapid effects can be a life-saving treatment in the emergency room for patients presenting with suicidal ideation.
Second, the effects of a single ketamine infusion are relatively short-lived – as almost all patients relapsed with depressive symptoms after a single infusion – so those with treatment-resistant depression will need repeated sessions.
“While intravenous ketamine is not yet FDA-approved for treating depression, it may still be used with off-label indications for those with severe depression and/or with a high risk of suicidal behaviors,” said Rhee.
Experts urge caution despite promise
Dr. Lama Bazzi, a psychiatrist in private practice in New York City, has had several patients receive ketamine infusions.
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“For a small subset of patients in a major depressive episode or struggling with suicidal thoughts, intravenous ketamine can be genuinely lifesaving,” Bazzi, who was not involved in the study, told Fox News Digital. “The relief they experience is almost immediate, offering them distance from the intensity of their emotions.”
However, she cautions that the medication should only be administered in closely monitored settings, such as clinics, to ensure safe treatment.
Ketamine is not a panacea, Rhee agreed, warning of the potential risk of abuse and addiction.
“It should only be used medically,” he advised.
Dr. Marc Siegel, Fox News senior medical analyst, noted in previous comments to Fox News Digital that ketamine is increasingly being used to treat severe depression, but emphasized that it should be administered under careful medical supervision because of its potential risks.
Study limitations
Although the studies compared ketamine with a placebo, some patients may have realized they were receiving the drug. This could have influenced how they reported their symptoms and how effective they perceived the treatment to be, according to the researchers.
“It should only be used medically.”
Another limitation is the small sample size of the studies, which could make the effects seem disproportionately magnified.
Also, as this was a review of many different studies, it is challenging to apply the findings to the general population, the researchers noted.
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“While long-term outcomes have not been studied, I believe that when patients are severely depressed or suicidal, ketamine is sometimes the only choice that almost always works,” Bazzi added.
Anyone interested in exploring alternative depression treatments should first consult a doctor.
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