The growing popularity of ketamine for treating pain and depression

What is ketamine?

Ketamine is a drug that is commonly used as a hospital anesthetic. It was introduced as an alternative to PCP that wouldn’t cause intense psychoactive results in certain patients. While it acts on different parts of the brain at the same time, ketamine mostly focuses on specific receptors and can help patients who are suffering from suicidal thoughts and acute depression. First synthesized in 1956, ketamine has had a long history of helping patients with mental health issues and can be used as an anesthetic at high doses.

What are the benefits of using ketamine?

Ketamine has been shown to alleviate depression and suicidal thoughts. In one incident that gained the attention of doctors and signified the possible positive effects of ketamine, a patient who was threatening to jump off a bridge and commit suicide received a shot of ketamine, which eliminated the suicidal thoughts for a full nine months. This type of long-lasting effect is what makes ketamine an attractive drug for use with patients that have intense mental health issues.

How does ketamine work to help depression?

In clinical trials, ketamine is administered in a controlled environment under the supervision of medical staff. There is a brief period after being given the ketamine when the patient will experience a psychoactive response similar to being high. This high is seen as a necessary step in getting the full benefit of ketamine and typically doesn’t last for more than half an hour. It’s the effects after this initial high that really benefit the patient.

Patients in these ketamine trials have all been diagnosed with treatment-resistant depression and have tried numerous medications to alleviate their symptoms. They start out with two infusions of ketamine a week for three weeks, and unless they start to feel the effects of depression come back, they don’t need any more than that. Some patients have described the initial high as like being in a pleasant dream state where there are no negative feelings at all. Most patients appear asleep during the initial 40-minute intravenous drip.

The results of these trials are remarkable, to say the least. Thirty percent of patients who try this ketamine drip for six weeks are cured of their depression and don’t come back for a booster because they never have their symptoms return. Those that come back for a booster shot show up more and more infrequently because the symptoms don’t come back as intensely if at all.

Medical staff are still not fully sold on ketamine as a solution for pain management and depression. When nurses were asked about their comfort using ketamine, a qualitative study revealed that most nurses feel they do not have sufficient knowledge in the area of ketamine to feel comfortable using it for pain control.

Who should use ketamine?

The American Journal of Clinical Care suggests the use of ketamine for acute care patients is effective in reducing opioid dependency for pain management.

Ketamine has become a popular method with medical staff when it comes to pain management in surgical patients. With the backlog in surgeries in the healthcare system, nurses who administer opioids to patients for pain management while they are waiting for corrective surgeries say that the result is a high tolerance for these opioids, rendering them useless in managing pain. Ketamine is an effective substitute where the effects are long-lasting, so fewer injections are needed.

The use of ketamine and the nursing profession

For nurses who are looking at alternatives to patient care that reduce the dependency on opioids and the number of injections, ketamine is a perfect alternative. Nurses with experience in this type of treatment have a leg up on their colleagues as the use of ketamine in different medical areas has been quickly gaining in popularity.

Travel nurses are in a unique position to learn about the different areas of pain management, including the techniques of administering ketamine to patients, as they are exposed to many areas of medicine. A travel nurse can be in a position to teach colleagues about the most recent research on the use of ketamine and what to expect when administering it.

If you are interested in this role and want to know how to become a travel nurse, there are many excellent online programs available to help you earn your degree. For example, you’ll find both an Online Accelerated BSN and an Online Direct Entry MSN offered at Elmhurst University for non-nurses. A quick Google search of the different levels of nursing can give you a good indication of which career path you want to pursue.

The pros and cons of ketamine use

Ketamine is not yet considered the first line of defense for therapies involving pain, depression, or other mental health disorders. It is used as a treatment for individuals who have tried multiple medications and treatments with no success. When a doctor recommends ketamine as a treatment, it is usually because nothing else will work for the patient. Ketamine is best used in intravenous drip form and can calm a patient immediately. The IV drip slowly introduces ketamine into the system and affects the parts of the brain that control mood and behavior. It also has an effect on how the brain receives and processes pain to effectively manage chronic pain. The ability of ketamine to provide long-lasting and quick relief for persistent cases of depression is an amazing breakthrough that is causing a stir in the medical community.

Benefits of ketamine use

Depression and anxiety are the leading causes of worldwide disability and the most prevalent mental health issues that cause suicidal ideas or actions. While 2 in 3 people who have depression can find respite in traditional antidepressants with therapy, the remaining 1 in 3 do not respond to traditional medications. When someone suffers from debilitating depression, anxiety, PTSD, or chronic pain, ketamine therapy is the last resort and has been very effective. A clinical evaluation must be done before administering ketamine, and that includes whether the subject has tried other methods or medications first as ketamine is only administered as a last resort for those with serious depression.

  • Fast acting

Ketamine intravenous infusions start to take effect within a few hours to ease the symptoms of depression. Researchers believe that ketamine stimulates a quick increase of glutamate, which is the main neurotransmitter in the brain. This neurotransmitter stimulates the growth of synapses in the brain, which helps restore vital neural connections that can be impaired by depression. These new neural connections create positive changes in brain function, which can reduce the symptoms of depression.

  • Highly successful 

In clinical studies, ketamine was found to help the majority of test subjects alleviate their symptoms, in some cases with no need for boosters. The trials offered subjects a six-week dose of ketamine injections at two doses per week and studied the effects of the drip and the after-effects. The drip took about 40 minutes to administer, followed by 20 minutes of psychoactive behavior where the subjects appeared to be in a daze or a dreamlike state. After this state, the ketamine took a few short hours to kick in, and subjects began to experience results quickly.

Thirty percent of subjects that received the six-week dosage didn’t return for a booster because their symptoms disappeared, so there was no need to come back. The rest of the subjects did come back for a booster, but the visits became less frequent as time went on, and eventually, most of the subjects reported their symptoms were either manageable or non-existent. The successful results of these studies indicate how powerful ketamine can be in relieving symptoms of depression.

More studies have shown that half the people with debilitating depression achieve relief of symptoms after one infusion, while the rest found relief after two or three infusions. The effectiveness of ketamine makes it a viable solution for those individuals who don’t find relief with other traditional therapies.

  • Relief from symptoms last

Ketamine differs from traditional depression medications because it is not a drug that needs to be taken every day for years the way most anti-depressants are administered. It doesn’t work after one treatment, but after six weeks of treatments, it seems to have a lasting effect with the help of some additional boosters. Ketamine stimulates changes in the brain that seem to develop into lasting relief from symptoms over the six-week course of a treatment cycle. Most subjects will experience a long-term relief of symptoms with the occasional booster needed when they feel they may relapse. The length of time ketamine helps relieve subjects of symptoms of depression is a much more positive outcome than having to take antidepressants for years before having to bump up the dosage because they stop working. Antidepressants are also very hard on the liver and can cause stomach upset, which are not side effects normally seen with ketamine.

Drawbacks of ketamine

Ketamine offers some major successes in dealing with depression and in some cases of the chronic pain relief, but like any other drug, it also has some drawbacks. When ketamine therapy is used in infusions, it can induce temporary psychoactive effects that can be alarming to some subjects. In clinical trials, the subjects are given soothing activities to perform like coloring or puzzles so that when they are ‘coming down from the high, it is a much more pleasant experience.

Ketamine must be approved for use only after a detailed evaluation by a doctor and can only be administered in a clinical setting. Subjects must be monitored because they can experience mild hallucinations, fuzzy vision, dizziness, and a sensation of floating. These side effects can affect the subject despite being given only a small amount of the drug intravenously. These potential side effects also mean that the subject must have someone drive them to and from the treatment, which can be inconvenient and not always possible.

For subjects with a history of substance abuse and addictive personalities, ketamine could be addictive and therefore not appropriate for everyone. The detailed medical evaluation done on potential subjects should screen out individuals who may suffer from addiction.

Other side effects of ketamine include:

  • Sleepiness
  • Seeing double
  • Feelings of confusion
  • Nausea
  • Stomach upset
  • Vomiting
  • Dizziness
  • Feelings of unease or paranoia

Other therapeutic uses for ketamine

Ketamine is only approved by the FDA as a general anesthetic, but it can be used in many therapeutic settings as an off-label drug. The primary use of ketamine is in general anesthesia where ketamine can be used for short-term sedation for surgeries. It can also be used to sedate patients when treating painful joint dislocations and fractures. In addition, it can be given to children or other uncooperative individuals when repairing a wound.

  • Treatment for pain 

In large doses, ketamine can cause effects much like the high that test subjects experience in clinical trials. In proper doses, ketamine can act as a pain reliever for trauma, fractures, arm or leg pain, abdominal pain, and lower back pain. Patients can experience immediate relief from these painful afflictions when given appropriate amounts.

  • Treatment for status epilepticus

Status epilepticus occurs when an individual has seizures that last longer than five minutes or experiences more than one five-minute seizure. Refractory status epilepticus (RSE) is when a person has a seizure that lasts longer than five minutes or has more than one seizure within five minutes.

RSE does not respond to traditional antiseizure medications, so it can cause brain damage and death for the sufferer. A study in 2015 showed that ketamine could treat RSE effectively by reducing seizures. More research is needed, but this would be a significant breakthrough if ketamine could help individuals with this disease.

  • Treating anxiety

Some research studies suggest that ketamine can help those with social anxiety disorder (SAD), which is an intense fear of social situations. A 2017 clinical trial showed that out of the 18 participants in the study, the majority were positively affected by ketamine treatments and showed some improvement in their social fear.

Risks to using ketamine

Even with all of the successes from clinical trials and studies, there are still some individuals who are at risk from using ketamine and should not take it. Most people who fall within a wide age range are safe to use ketamine in controlled doses and when administered correctly, but there are some who are at risk from the drug.

The people at risk from taking ketamine include individuals who have:

  • Unstable heart and blood vessel functions – Ketamine could result in an increase or decrease in blood pressure and heart, which could result in abnormal heart rhythms. An evaluation done by a medical professional on the subject should indicate whether this is a danger.
  • Respiratory conditions – If ketamine is given in too high a dose or too quickly, it can cause respiratory depression.
  • Undergone a recent operation – Dangerous emergence reactions including agitation or confusion may occur in the recovery period after an operation if a patient is given ketamine.
  • High intracranial pressure – Doctors need to keep a close eye on anyone who has this condition, as ketamine can increase pressure in the cranium.
  • Liver injuries or dysfunction – Ketamine can exacerbate liver dysfunction and cause it to worsen.
  • High blood pressure – Taking ketamine could result in an aneurysm, uncontrolled high blood pressure, a heart attack, aortic tear, or a stroke.
  • Schizophrenia – Ketamine is not suitable for individuals who suffer from schizophrenia as it could cause symptoms to worsen.
  • Pregnancy – Ketamine should not be administered to pregnant women or breastfeeding women as there is very little research done on the effects on a fetus.

Studies on ketamine use are very positive and show a tremendous amount of promise in helping individuals who suffer from depression and chronic pain. Clinical trials show that those who suffer from depression and are unable to get relief from traditional medications can benefit greatly from a six-week therapy via an intravenous ketamine drip. These trials have shown why so many people in the medical community are excited about the potential that ketamine can have in treating depression, one of the most prevalent mental health issues in the country. Anxiety is another common mental health affliction that has also seen some positive results with the use of ketamine.

The biggest benefit of using ketamine for depression and pain treatment is that it is fast acting, in some cases within a few hours. After the initial ‘high’ state wears off, most of the subjects feel better within a few hours of one dose. In other cases, it only takes two or three doses. With such positive results in clinical trials, it would not be surprising to see ketamine being used for a vast array of conditions in the near future.

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