Ketamine for Treatment Resistant Depression in Chevy Chase, Maryland

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A diagnosis of treatment resistant depression is nothing short of devastating. Imagine, years and years of battling depression, trying medication after medication, doctor after doctor, lifestyle change after lifestyle change, therapist after therapist only to reach the conclusion that you somehow have a version of depression that is resistant to treatment! This conclusion can feel both utterly hopeless and entirely unfair. This is particularly true for the patient that has bravely sought and tried to get well for years without avail. In truth, everything you are feeling is justified! Depression is unfair. If you are feeling hopeless, it is not unwarranted. If you are feeling scared, you are not alone. But, though you may have heard it before, there is hope.

What exactly is treatment resistant depression?

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Treatment-resistant depression (TRD) is defined as major depressive disorder (MDD) in adults who have not responded to at least two different antidepressant treatments in the current moderate to severe depressive episode. Just two failed medication attempts during a moderate to severe depressive episode can lead to a TRD diagnosis! In essence, “A patient is considered to suffer from treatment resistant depression (TRD) when consecutive treatment with two products of different pharmacological classes, used for a sufficient length of time at an adequate dose, fail to induce a clinically meaningful effect.” Yet, paradoxically, research suggests that up to two-thirds of patients do not respond to their initial treatment with an antidepressant meaning one more failed attempt results in a diagnosis that is tough hear.

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In reality, the number of treatment resistant cases tends to add up to about 10%–30% of cases. For this percentage of patients, life is extremely challenging because medication is not effective. Try as they might, traditional antidepressants do not lead to even a partial response in improvement, meanwhile the patient faces impairment, poor quality of life, suicide ideation and attempts, self-injurious behavior, and higher odds of relapse.

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This is really no way to live and until recently, doctors did not have much in the way of answer—at least not an answer that patients wanted to hear... Until now.

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The Progress of Research for Treatment Resistant Depression

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In a recent report, “How New Ketamine Drug Helps with Depression,” Yale researchers respond to FDA’s reprove approval of the nasal spray called esketamine, which is derived from ketamine. John Krystal, MD, chief psychiatrist at Yale Medicine and one of the pioneers of ketamine research in the country is a proponent of ketamine and is encouraged by the response to ketamine.

“This is a game changer…The drug works differently than those used previously, he notes, calling ketamine “the anti-medication” medication. “With most medications, like valium, the anti-anxiety effect you get only lasts when it is in your system. When the valium goes away, you can get rebound anxiety. When you take ketamine, it triggers reactions in your cortex that enable brain connections to regrow. It’s the reaction to ketamine, not the presence of ketamine in the body that constitutes its effects,” he says.”

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While he is referring recent surveys with intranasal esketamine, Dr. Krystal is still very much focused on the study of treatment using intravenous ketamine.

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We like this study because Dr. Krystal is a credible source and an early pioneer in ketamine studies. Much of the current information and language framing ketamine conversations is derived from his work. It is worth noting that, “Research into ketamine as an antidepressant began in the 1990s with Dr. Krystal and his colleagues Dennis Charney, MD, and Ronald Duman, PhD, at the Yale School of Medicine. At the time (as is still mostly true today) depression was considered a “black box” disease, meaning that little was known about its cause.”

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In the early ‘90s, researchers were theorizing the cause of depression. The most common theory was “serotonin hypothesis,” which essentially pointed to low levels of a neurotransmitter called serotonin, hence the development of SSRIs. However, long-term, researchers discovered that 80 percent are neurotransmitters are actually GABA and glutamate.

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In short, “Together, the two neurotransmitters (GABA and glutamate) form a complex push-and-pull response, sparking and stopping electrical activity in the brain. Researchers believe they may be responsible for regulating the majority of brain activity, including mood. Additionally, intense stress can alter glutamate signaling in the brain and have effects on the neurons that make them less adaptable and less able to communicate with other neurons.”

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Ultimately, what this means is the stress and depression themselves make it progressively harder to deal with negative events, becoming a vicious cycle for people struggling with difficult life events.

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Intravenous Ketamine for Treatment Resistant Depression

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Historically, studies from Yale research labs show that ketamine (widely used as anesthesia during surgeries), “triggers glutamate production, which, in a complex, cascading series of events, prompts the brain to form new neural connections. This makes the brain more adaptable and able to create new pathways, and gives patients the opportunity to develop more positive thoughts and behaviors. This was an effect that had not been seen before, even with traditional antidepressants.”

For the last twenty years, researchers have consistently “experimented with using subanesthetic doses of ketamine delivered intravenously in controlled clinic settings for patients with severe depression who have not improved with standard antidepressant treatments. The results have been dramatic: In several studies, more than half of participants show a significant decrease in depression symptoms after just 24 hours. These are patients who felt no meaningful improvement on other antidepressant medications.”

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Yale is not the only research group studying the effects of intravenous ketamine—in fact there are numerous studies demonstrating the effectiveness of IV ketamine treatment for depression with many patients feeling relief much sooner than with traditional antidepressants. Ketamine infusion therapy has a high rate of success when it comes to treating persistent depression and several studies indicate that over half of people with TRD achieve significant symptom relief after a single infusion--while many more find relief after two or three infusions.

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To find out if ketamine is right for you today, schedule a consultation with us. We offer affordable ketamine solutions and our doctors have vast experience with Walter Reed patients and a deep understanding of the suffering related to treatment-resistant depression.