An increasing number of Israeli psychiatrists have started using ketamine as part of the medical treatment for depression and chronic pain. This follows a series of studies worldwide that found it to be effective and very fast at treating manic depression and suicidal tendencies without significant side effects.
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Ketamine has been in medical use for 50 years as an anesthetic. Anesthesiologists are the only ones allowed to administer it to patients in Israel, with the exception of cases in which special permission has been granted for research purposes. At present, there are several studies being conducted here to examine the use of ketamine to fight depression.
The great excitement in the mental health community stems, among other things, from ketamine's speed. Treatment with conventional antidepressants can take weeks or months to see any effect, but with ketamine infusions, patients report a fast reaction and improvement in their feeling within two or so hours of receiving treatment.
Experts attribute these results to the way in which ketamine works on the brain’s mechanisms: While conventional antidepressants affect certain brain circuits and the chemicals (neurotransmitters, such as serotonin and norepinephrine) that pass along signals from one nerve cell to another, ketamine operates by blocking the signals of the NMDA receptors that play an important role in the activity of the memory and other cognitive functions.
The mental health community was not initially convinced, but a series of positive studies published in recent years has changed the picture.
“We have recently been witnessing a boom of studies on the subject of ketamine,” said Dr. Revital Amiaz, director of the Clinic for Depression, Anxiety and Electroconvulsive Treatment at the Sheba Medical Center, Tel Hashomer. “We’re talking about some 20 studies, and another three meta-analyses that combine and summarize the results of the most recent trials. This information already sums up trials conducted on about 800 patients. And the results are becoming increasingly convincing.”
Amiaz has been treating some of the patients who come to her clinic with intravenous ketamine infusions since last September. The treatment is administered with the permission of the Helsinki Committee, as part of a study she is conducting in cooperation with the heads of the hospital’s anesthesiology and psychiatric departments.
The clinic assesses the patients’ condition and chooses those for whom ketamine is suitable. The treatment includes a round of six ketamine infusions, at a dosage of half a milligram, and lasts for 40 minutes.
“We have seen that there are no side effects," says Amiaz. "Some reported a certain feeling of indifference, but most report a pleasant sensation. Ketamine’s unique quality, as seen in the studies, is that it causes the production of new brain cells [neurogenesis]. This process is defective in people suffering from depression, where there is no neurogenesis. Medications can also do that, but far more slowly,” she says.
Amiaz says the dosages given to patients are low and she has not encountered reports of hallucinations, nor have there been any in the research studies. “People sometimes described a feeling of severance from their body, but not hallucinations. Ketamine’s use as a [recreational] drug is different – it’s mixed with additional substances and isn’t under supervision.”
Amiaz also claims patients do not develop an addiction to ketamine, mentioning a study which found that patients with a background of alcoholism in the family responded better to treatment with ketamine.
She believes the effectiveness of ketamine for treating psychiatric problems is broader and not limited merely to depression. Ketamine is effective in treating anxiety (including social anxiety) and obsessive-compulsive disorder, and studies have found it particularly effective for treating suicidal tendencies.
Some trauma centers worldwide – for example, Mount Sinai Hospital in New York – give ketamine to patients who arrive in the emergency room with anxiety and suicidal tendencies. “I compare the effectiveness of treatment with ketamine to that of electroconvulsive treatments,” Amiaz says.
Ketamine, she notes, has less of a stigma, works faster and doesn’t expose the patient to the dangers involved in anesthesia. In addition, electroconvulsive therapy has cognitive side effects: it affects short-term memory and historical memory.
“But it’s important to emphasize that ketamine alone is insufficient. It’s a kicker, it accelerates the process of neurogenesis. But in order to maintain the situation, you have to continue with medication.”
Amiaz has treated about 10 people with ketamine over the last four months. She admits it doesn’t work for everyone, but that "anyone who responds to the treatment responds immediately, and in an impressive manner. One of the patients said that on the day of the treatment, he found the energy to go to a fitness club, and another said he cleaned up the house that day.”
Local reports about ketamine patients join what looks like an international community that is forming. Its first signs can already be found on the Internet, in forums and on video clips, where patients report on the treatment's successes and failures.
However, there is still a research gap regarding its long-term effects. “At the moment, it looks as though the advantages of ketamine are greater than the disadvantages,” says Dr. Shaul Lev-Ran, director of addiction medicine services at Sheba. “This is a substance that can relieve depression and suicidal tendencies effectively, but we don’t know enough about its long-term consequences."
Meanwhile, the patients themselves don’t seem to be concerned, with the long term an eternity for them. “Psychiatry is the only medical field in which people suffer so much that they’re willing to put an end to their lives although they aren’t dying,” notes Amiaz. “I had a patient who suffered both from serious depression and cancer. She once said to me: ‘I would prefer the cancer to recur than the depression.’”