Depression is a national epidemic. Cases of major depression have risen by 33% since 2013. In the United States, there are over 16 million people who suffer from depression and that number is increasing at an alarming rate, especially among teenagers and Millennials where suicide has soared to an all-time high. The number of Americans taking antidepressants has skyrocketed too. Nearly 13% percent of Americans age 12 or older reported taking an antidepressant within the last month.
The use of antidepressants is a mixed bag. For some, they can work well but take a long time to provide meaningful relief. For others, they provide minimal to no benefit at all (this is called Treatment-Resistant Depression or TRD). And for others, long-term use of antidepressants can make depression worse and increase the risk of suicide. Furthermore, long-term use of conventional antidepressants has been found to increase the risk of Alzheimer’s and cardiovascular disease. (Note: Because of the side effects of abrupt withdrawal, if you are currently taking an antidepressant, do NOT discontinue it without proper medical supervision.)
Clearly, we need to take a new approach to the diagnosis and treatment of depression! And clearly, as with any disease, the best approach is always to find and treat the root cause (click here to learn how to do this with depression). When it comes to conventional treatment, there is an urgent need for treatments that are more effective, work quicker, and have fewer side effects.
Ketamine is a medication that is used intravenously for anesthesia, but a number of studies have shown that a single intravenous dose of ketamine can produce a rapid and profound antidepressant effect. Research indicates that regular intravenous treatment is extremely effective but is expensive and impractical. Oral ketamine, on the other hand, is broken down by the liver before it enters the bloodstream, so this option is out. As an alternative, intranasal administration has been investigated. Intranasal drug delivery provides a direct and rapid therapeutic effect on the brain. Intranasal administration avoids problems related to gastrointestinal absorption. It also avoids the inconvenience and expense of intravenous therapy.
In a randomized, double-blind, placebo-controlled, crossover clinical trial conducted in 20 patients with severe depression, researchers at the Icahn School of Medicine at Mount Sinai, New York, tested the safety, tolerability, and effectiveness of intranasal ketamine in patients who had failed prior antidepressant treatment. The researchers found that a single intranasal dose of ketamine outperformed placebo. The response rate was 44% versus 6%, respectively. Anxiety ratings also decreased significantly more with ketamine. Patients showed significant improvement in depressive symptoms within just 24 hours. Intranasal ketamine was well tolerated and had far fewer side effects compared to conventional antidepressants. Patients experienced nearly 7 days of relief of depression after just a single dose of intranasal ketamine.
Comments from Dr. Thomas: Intranasal ketamine represents a genuine breakthrough, especially for Treatment-Resistant Depression. Intranasal ketamine is not commercially available, however. It must be custom compounded. Most doctors have little to no experience in the use of custom compounded medications. Over the past 30 years, I have been using such medications to meet my patient’s specific needs. If you or someone you love is suffering from depression and would like to learn if intranasal ketamine may help, please contact my office.
