Major depression is one of the most common mental disorders in the United States. According to the National Institute of Mental Health in 2015, an estimated 16.1 million adults aged 18 or older in the United States had at least one major episode in the past year. This number represented 6.7% of all US adults. It is estimated that as many as two-thirds of people with depression aren’t helped by the first antidepressant try. Up to a third don’t respond to several attempts at treatment.
For people who do not respond to medication treatment, the usual treatment alternatives include augmenting medications with psychotherapy or Electro-convulsant therapy (ECT) by causing an electrically induced seizure. While psychotherapy can be effective, most research has shown that 60% of patients improved only when medications were used in addition to therapy. ECT has a success rate of between 50-70%, but treatments may lead to side effects of temporary confusion, as well as being labor intensive requiring facilities equiped with a psychiatrist as well as an anesthesia provider.
Recent research as shown that Transmagenetic Stimulation (TMS) or using high powered magnets can be helpful in treatment resistant depression. Unfortunately the results from research into the effectiveness of TMS for treatment resistant depression is only about 30%.
Recently there has been great excitement in psychiatry over the use of ketamine infusions for the treatment of difficult to treat and treatment resistant depression. Ketamine is a relatively safe anesthetic agent that when given by intravenous (IV) infusion has been shown to successfully improve depression rating scales in patients by 70% after the first treatment. In one particular study, patients were taken off their antidepressant medications and then received up to six IV infusions over 12 days and their overall response rate was 71 %. The duration of successful response from the final infusion was variable but ranged between 25 and 168 days.
Ketamine can be administered in a clinic setting, and does not require any additional staffing for patient safety. The treatments last approximately 40 minutes, and the patient is monitored for approximately 1 hour after treatment to assure full recovery from the anesthetic agent. In no documented cases has there been noted any memory loss that may acompany ECT.
Our hope is that we as a clinic may bring ketamine infusions as a treatment alternative to our patients with difficult to treat depression, as well as other illnesses which have shown a positive response to this treatment such as post traumatic stress disorder and obsessive-compulsive disorder.