What Is Ketamine?
Ketamine is a drug that has multiple benefits on the human body (when taken in the right amounts). Ketamine was discovered as an anesthetic medicine that got FDA approval in 1970 for being used as an analgesic (painkiller) and anesthetic agent. This drug is famous for use in the emergency department for quick pain relief (especially in opioid-resistant pain in palliative care). Ketamine infusions are effective in managing chronic pain, depression, and mood disorders.
The miraculous drug was discovered in 1965 and was frequently adopted as a sub-anesthetic agent i.e. it enhanced the effects of anesthesia during surgeries. Surgeons initially used this drug to enhance the effect of anesthesia preoperatively. It gained popularity in the 1970s when it was widely used for surgical anesthesia during the Vietnam war. Wounded war soldiers were given ketamine to ease them out during surgeries.
The use of ketamine had the added effect of an antidepressant. Soldiers were motivated and felt mood improvements with the use of ketamine.
According to research, ketamine can be used as the following:
- Anesthetic
- Analgesic (in small amounts)
- Hypnotic
- Neuroprotective drug
- Anti-depressant
Despite the immense medical and health benefits imparted by ketamine, the drug is notorious for its abuse potential. In modern times, it is frequently used as a “party drug” or a “recreational drug”. Though psychedelic in nature, latest studies have explored different uses of this nonselective N-methyl-D-aspartate (NMDA) receptor antagonist (other than anesthesia). These studies have advocated ketamine’s role in substance abuse management, pain relief, and neuroprotection.
What Are The Benefits Of Ketamine Infusion?
Ketamine is effective in bringing about relief from a variety of underlying medical conditions. For nearly two decades the intravenous infusion of ketamine has helped hundreds of people achieve an improved quality of life. By treating maladies like Post-traumatic stress disorder, anxiety, Obsessive-compulsive disorder, and chronic pain disorders, ketamine infusions has improved physical health, quality of sleep and called for better nutrition in patients. Numerous studies have shed light on the miraculous effects of ketamine.
The drug has proven to be extremely beneficial for the body when taken according to a doctor’s prescription. Many studies suggest that long-term effects are seen with infusions of ketamine.
Numerous studies have promoted the use of ketamine for different medical conditions. The most evident ones include:
Anxiety and Depression
The greatest and potent action of ketamine is on anxiety disorders and depression. According to a study published in the Journal of Psychopharmacology, the use of ketamine was linked to a reduction in symptoms of generalized and social anxiety disorders. The drug is even considered as a therapeutic alternative for the management of treatment-refractory anxiety disorders.
Suicidal ideation is a condition where the patient has suicidal thoughts. It is common in severe depression patients who even attempt to commit suicide (suicide attempts). Such patients are unresponsive to a majority of drugs and psychotherapy. That being said, there has been significant studies done on the use of ketamine to treat the very serious ideation. A detailed review of 14 meta-analyses and 15 trials, reveals that ketamine administration can be a promising treatment for patients with suicidal ideation.
Suicidal ideation is considered a psychiatric emergency that needs immediate attention. In a study carried out on 133 major depressive disorder patients, it was concluded that ketamine infusions lead to a reduction in suicidal thoughts and improvements in anxiety and depression.
Another investigation found that ketamine is an effective and cost-effective antidepressant that works pretty rapidly. It is safe for use in palliative care patients. Alternatively, the drug is also seen to be very effective in treating post-traumatic stress disorder and obsessive-compulsive disorder only when given as a sub-anesthetic dose.
Individuals with severe mood disorders and treatment-resistant depression can be cured with intravenous doses of ketamine. According to various reviews, the benefits of ketamine usage for anxiety and depression outweigh the potential risks and adverse effects of the drug. A study published in The American Journal of Psychiatry promotes the rapid antidepressant effect achieved by NMDA modulation with ketamine use.
Ketamine is associated with robust antidepressant and anxiolytic effects, a study suggests. Patients suffering treatment-resistant depression show improvements in symptoms when given ketamine.
Another study praises the potency of ketamine in managing depression patients. It declares that the drug rapidly prevents bursts of depressive states. This leads to a rapid elevation of mood.
Pain Management
It has already been pointed out that the drug acts as an analgesic when used in small quantities. According to research, ketamine is effective in:
- Relieving postoperative pain
- Wheezing off opioid consumption
- Reducing chronic cancer, and non-cancer pains
Another research speaks highly of the analgesic effect imparted by ketamine in cases of chronic refractory pain. Therefore, it can be justly used for palliative care patients.
In severe cases of pain, doctors prescribe opioid derivative drugs that have very high addiction potential. The analgesic effect of ketamine is similar to opioid drugs but is comparatively safer. According to meta-analysis, ketamine reduces pain and also decreases the opioid doses in patients after total knee arthroplasty.
Another review of thirty-seven clinical trials revealed that a single dose of ketamine is so potent that it caused a decrease in required quantities of IV and epidural morphine. This, in turn, is beneficial for those seeking pain management treatment while avoiding potential opioid dependence.
For those that successfully use opioid medications for pain management, studies have also seen improved analgesia effect when a combination of ketamine and the opioid derivative drug is used. A study declares that a combination of low-dose ketamine with morphine provides a far greater analgesic effect as compared to morphine alone.
According to the American Academy of Pain Medicine, ketamine is found to be extremely potent in treating uncontrolled chronic pain. As per a review, ketamine has been used for the last 50 years for analgesia. The miraculous drug is efficacious for pain conditions in nonspecific neuropathic pain, fibromyalgia, phantom limb pain, and postherpetic neuralgia.
Fibromyalgia patients are faced with the trouble of chronic pain and muscle stiffness. A study analyzed the effect of ketamine on pain in fibromyalgia patients. In this study, a visual analog scale (VAS) was used to assess pain intensity. It was concluded at the end of the study that NMDA modulation by ketamine leads to a reduction in muscular hyperalgesia and muscle pain at rest. This particular drug is an effective adjunct to general anesthesia, a study suggests.
Insomnia and Sleep Disorders
Patients with depression and bipolar disorder are frequently faced with sleeping issues and insomnia. According to research, ketamine improves symptoms of depression and aids in better sleep. In a detailed study, a link was found between sleep induction and ketamine infusion.
Depression patients have difficulty sleeping and the extent of the disease can be measured using the baseline delta sleep ratio. In a study, it was found that ketamine showed improvements in sleeping patterns as well as in depression symptoms. Researchers also noted an increased expression of the adenosine receptors (A1R) in the forebrain that helped inducing sleep in depression patients.
Similar to valproate and lithium, ketamine can increase slow-wave sleep and improve neuroplasticity in patients suffering from mental health disorders. The drug also plays a positive role in providing pain relief to sleep disorder patients (central sleep apnea)
The use of ketamine is also linked to improvement in the circadian rhythm/clock inside the body of major depressive disorder patients.
Some scientists still believe that high doses of ketamine can temporarily put your brain to rest. However, as per a study, ketamine has no notable effect on sleep architecture. The changes in nocturnal sleep time, quality of sleep, and the number of awakenings were the same for burns and non-burns patients.
It was found in a study that repeated infusions of ketamine lead to improvements in sleep in patients with insomnia. Another account states that very low doses of sublingual ketamine improve mood, cognition, and sleep quality in patients with refractory unipolar and bipolar depression.
Advanced cases of major depressive disorder are prone to committing suicide. Waking up at night triggers suicidal ideation. In such cases, ketamine can be efficiently used. Patients taking ketamine reported evident reductions in nighttime wakefulness. The effect had beneficial outcomes on the sleep quality of the patient as well as the suicidal tendency.
Anesthesia
Ketamine was predominantly used as ambulatory anesthesia and was once advertised as “a rapidly acting, non-barbiturate general anesthesia” for surgeries. According to a study published in the Journal of Anesthesia Essays and Researches, ketamine is a highly lipid-soluble chemical that is metabolized in the liver.
Ketamine was well known for its use as an anesthetic in critically ill patients, emergency use, burn management, electroconvulsive therapy, and more. According to research, patients showed greater improvements in symptoms when ketamine was used as anesthesia as compared to other drugs. However, the surgeons must keep in mind the adverse effects of ketamine dosage.
Repeated introduction of ketamine anesthesia in mice leads to improvements in mood and reduction in anxiety, a 2018 study suggests.
How Does Ketamine Work?
Chronic Pain
Ketamine brings about chronic pain relief (and Complex Regional Pain Syndrome) by blocking the N-methyl-D-aspartate (NMDA) receptor. Ketamine is a noncompetitive NMDA receptor, antagonist. This receptor is present in the spinal cord and the brain. The NMDA receptor amplifies pain signals.
Pain perception in chronic pain disorders is the result of overactive pain receptors. This drug reboots the brain function to normal mode and soothes the hyperactive pain receptors. In Complex regional pain syndrome (CRPS) the drug works to improve conditions of central sensitization.
Central sensitization is the state where the body elevates the intensity and number of pain signals with time. Ketamine essentially resets the pain signaling. It is most effective when other treatment options have failed. By the blockade of NMDA receptors (in the brain and spinal cord) peripheral nerve pain transmission is intercepted before it reaches the CNS. Small quantities of ketamine lead to the inactivation of these receptors, thus, providing analgesia.
According to a study, the pain-killing effect is brought about by the blockade of NMDA and HCN1 receptors plus a role is also played by the opioid system.
Mood Disorders And Depression
Ketamine acts on and blocks the NMDA receptors. This results in an increase in the levels of two chemical messengers in the brain i.e. serotonin and norepinephrine. These chemical messengers effectively improve mood and provide positive energy.
Ketamine also acts as an AMPA receptor stimulator. The activation of AMPA receptors leads to the release of brain-derived neurotrophic factor (BDNF) which in turn stimulates the production of new connections between neurons.
This formation of new neural connections is beneficial because a lack of these connections is seen in patients suffering from mood and depressive disorders. Improvements in sleep and cognition are also seen with these new connections.
An important neurotransmitter of the brain is glutamate that influences the formation and number of brain connections (synapses). Glutamate acts with another neurotransmitter GABA to maintain a healthy, optimally working nervous system.
If an imbalance exists between these neurotransmitters then anxiety, sleep disorders, and depressive disorders occur. Therefore, abruption in the glutamatergic system is linked to major depressive disorder.
Evidence suggests that NMDA blockade by ketamine leads to a cascade of events that are the cause for the rapid antidepressant effect. However, there are some common short-term side effects associated including
- Nausea
- Vomiting
- Dizziness
There are no long-term side effects associated with IV ketamine use.
According to research NMDA receptor antagonists are linked to antidepressant effects. Ketamine is responsible for increasing neuroplasticity despite blocking the NMDA receptors. Its binding to the receptor prevents phosphorylation of eFF2 and increases levels of brain-derived neurotrophic factor (BDNF).
Elevated levels of glutamate and BDNF improve symptoms of depression in patients, a study suggests. Therefore, mood elevation is seen with this drug.
Suicide ideation is reduced by increasing neuroplasticity. Ketamine enhances neuroplasticity and imparts rapid anti-suicidal effects in major depressive disorder patients, a study suggests.
Anesthesia
Ketamine provides dissociative anesthesia. It exists in the form of two different enantiomers i.e. Racemic ketamine (R) and (S) ketamine. According to a study, S type of ketamine is more effective (threefold) than R type. The dissociative anesthetic effect along with the analgesic effect is brought about by the interaction of different receptors (mainly NMDA receptors) and the drug.
What Conditions Can Ketamine Treat?
Ketamine can be used to treat anxiety and different types of depression disorders associated with suicidal ideation. The drug can also play a vital role in the management of post-traumatic stress disorder (PTSD), chronic pain disorders and mood disorders.
Indications for ketamine infusion are as follows:
Pain
Ketamine infusions and oral drug forms can be used in the management of different pain disorders:
- Chronic Pain
- Chronic Regional Pain Syndrome (CRPS)
- Migraines
- Neuropathic pain
Mood Disorders
Anxiety Disorders
Ketamine can be effective in treating issues such as generalized anxiety disorder and different types of phobias including agoraphobia, claustrophobia, etc.
Depression Disorders
The drug is capable of alleviating symptoms of depression too. You can see improvements in the following depression disorders with ketamine usage:
- Bipolar disorder
- Major depressive disorder
- Postpartum disorder
- Post-traumatic stress disorder
Amblyopia
According to a study, ketamine, when used as a subanesthetic can restore vision in patients suffering from amblyopia.
Neurodegenerative Diseases
The versatile drug has a wide variety of effects. Therefore, it can be used in the treatment of different neurodegenerative diseases including:
- Alzheimer’s disease
- Parkinson’s disease
Anesthetic
The drug can be used as a sub-anesthetic alongside other drugs such as propofol, etc. It is also employed as preoperative general anesthesia.
What To Expect?
Here is what you can expect when receiving Ketamine Infusion therapy at Pacific Ketamine Group:
1. Free Consultation
The first step is a consultation with an expert. Here the patient provides their complete medical history to the healthcare provider. The physician then carries out a physical examination. The severity of symptoms is noted and a treatment plan is given accordingly.
At the Pacific Ketamine Group, we want to ensure that all patients feel completely comfortable with the treatment they undergo; Thus, we encourage the patients to ask as many questions regarding the procedure. To schedule your free consultation, please call us at (310) 928-6863.
2. Ketamine Infusions
At the Pacific ketamine group, ketamine is administered via an intravenous pathway. The patients are reclined on a comfortable recliner and given IV infusions of ketamine. The highly professional team of doctors, nurses, and medical assistants pays a lot of importance to impart maximum comfort. You are provided with the following items to soothe you during the infusions:
- Pillow
- Blankets
- Noise-canceling headphones with calming music
The drug is safe to be used as per a doctor’s prescription. However, abuse or misuse of the drug can lead to the following complications:
- Bladder and Bowel Dysfunction
- Dizziness and Lightheadedness
- Confusion and hallucinations
- Vision Issues
- Swallowing difficulties
3. Relief
How soon will you see an improvement? Unlike traditional drugs, the effects of Ketamine IV therapy are almost immediate. Most of our patients notice improvement while they are having their treatment, while other see improvement a few hours after their first Ketamine infusion.
To learn more about what you can expect when receiving Ketamine Infusions at Pacific Ketamine Group, please call (310) 928-6863.
Am I A Good Candidate For Ketamine Infusion?
The use of ketamine has proven to be a ray of hope for many. Ketamine infusions act as a viable alternative therapy for chronic pain management and mental health disorders. Many patients suffering for anxiety and mood disorders are resistant to medications. Ketamine infusions has proven to be extremely effective when used for treatment resistant anxiety disorders, depression disorders, Post-traumatic stress disorders, and Obsessive-compulsive disorders.
The criteria for a good ketamine infusion candidate is as follows:
1. You Are Suffering From A Mental Health Disorder
If you are suffering from any of the following disorders then you are a good candidate for a ketamine infusion:
- Anxiety disorders (generalized, social, or phobias)
- Bipolar disorder
- Major depressive disorder (MDD)
- Postpartum depression
- Post-traumatic stress disorder (PTSD)
- Obsessive-compulsive disorder (OCD)
- Depression with suicidal ideation
2. You Are Diagnosed With A Pain Disorder
If you are tired of suffering from chronic pain or are diagnosed with one of the pain disorders:
- Chronic pain
- Complex regional pain syndrome
- Neuropathic pain
- Migraines
3. You Are Resistant To Therapy
In most refractory cases where traditional therapy doesn’t work, ketamine is introduced. If you have a mental health or pain disorder that doesn’t seem to respond to any medicine, you should try getting IV infusions of ketamine.
The ideal candidate for IV infusion of ketamine should have the following features:
- Does not abuse alcohol or other medicinal drugs
- IV ketamine is NOT the first line of treatment for chronic pain/psychiatric disorders
- Has a history of psychosis and increased intracranial pressure (ICP)
- Is not pregnant or planning to be pregnant
- Does not suffer from uncontrolled hypertension or cardiovascular disease
If any of the criteria above apply to you, please contact the Pacific Ketamine Group at (310) 928-6863 to schedule a free consultation with Dr. Ananth!
Summary
The notorious party drug ketamine has proven as an effective painkiller and antidepressant when taken with care. Its commonly used as an sub-anesthetic in the emergency department. The analgesic effect is best when given for postoperative pain. Ketamine and its NMDA antagonist activity has shown to work magically in the management of chronic pain disorders. The antidepressant effect of ketamine is also attributed to the NMDA antagonist activity. The rapid antidepressant effect allows for its usage in the management of anxiety disorders and mood disorders. Other mental health disorders including PTSD and OCD can also be well managed with this drug. Improvements in social anxiety disorders and phobias has also been seen with the use of ketamine. Ketamine also stops the amplification of pain and elevates levels of BDNF to reduce symptoms of depression. It is an ideal drug for refractory depression and opioid withdrawal cases.
If you are interested in learning if Ketamine Infusions are right for you, please call (310) 928-6863 to schedule a free consultation with Dr. Ananth!
