Research Shows Ketamine Could Be an Answer for Treatment-Resistant Depression

Generally speaking, most people today either know someone dealing with depression, or have struggled with depression themselves. 

While many individuals can be successfully treated by a combination of medication or talk therapy, there are some who continue to experience symptoms after trying several treatments.

Recent research has highlighted ketamine as a potential treatment for treatment-resistant depression (TRD), so a research team at Mass General, led by Maurizio Fava, MD, decided to explore the effectiveness of various dosages.

Some History on Ketamine and TRD

If you have heard of ketamine, chances are it has been in a negative context due to its reputation for being used illegally as a recreational “club drug.”

However, according to the World Health Organization, it was the most widely-used battlefield anesthetic in the Vietnam war, and has practical uses in anesthesia, sedation and pain management.

TRD is a complicated condition because there are only four FDA-approved drugs used to treat it, and only three approved non-pharmacological treatments.

While not yet FDA-approved, there has been a steady flow of research showing ketamine provides rapid symptom relief. Most of these studies used a standard, subanesthetic, intravenous dosage of .5mg/kg, thus leaving researchers with a question about the effectiveness of other dosage levels.

The Research

To test a few treatment options, Mass General researchers created a study that evaluated the effects of four dosages, and an “active” placebo that induced side effects so participants would not be biased by being able to tell they were not receiving the ketamine treatment.

The study was designed so neither researchers, nor participants knew who was receiving what treatment during the study.

Participants were evaluated using a standard depression scale, as well as additional methods to capture mood and suicidal thoughts.

Once evaluations were complete, researchers realized participants that received 0.5 mg/kg and 1.0 mg/kg of ketamine showed significant improvement in symptoms for three days after initial treatment.

“These results support the clinical observation that one size – in this case the most studied dose of 0.5 mg/kg – does not fit all, as some patients may require a lower-than-average dose; and each patient needs a tailored treatment plan that may include ketamine, together with other medications and talk therapy. We still do not understand which factors play a role in determining lack of response to treatments or which is the best possible strategy for patients suffering from severe depression.”

– Cristina Cusin, MD, Department of Psychiatry

In the future, researchers hope to explore the efficacy of even lower doses for certain patients; the efficacy of repeat doses; and whether fewer, higher doses of ketamine would be beneficial in reducing the need for frequent usage.

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