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Ketamine offers hope for treatment-resistant depression

A new study has demonstrated the effectiveness of ketamine in treating severely depressed veterans. The research sheds light on the real-world application of intravenous (IV) ketamine infusions, offering hope for people suffering from treatment-resistant depression.

Ketamine also shows promise for individuals with complex mental health needs who have struggled to find relief through conventional treatments. 

Ketamine infusions 

The researchers analyzed the outcomes of 215 veterans who received IV ketamine treatments at various Veterans Affairs hospitals across the nation. 

These individuals, who had not found relief from traditional depression treatments such as antidepressants or talk therapy, embarked on a six-week course of ketamine infusions. 

Remarkably, nearly half of the participants witnessed a meaningful decrease in their depression scores, with one quarter experiencing a reduction by half and about 15% achieving full remission.

Significant advancement 

The research was led by Dr. Paul Pfeiffer and Dr. Avinash Hosanagar, both faculty members in the Michigan Medicine  Department of Psychiatry and practitioners at the VA Ann Arbor Healthcare System (VAAAHS).

The experts emphasized the importance of their findings, particularly noting that ketamine’s impact, while not universally dramatic, represents a significant advancement in treating those who have exhausted other treatment avenues. 

Measurable responses

“These findings ratchet down the hype about ketamine a bit, because we don’t see dramatic improvement after just one infusion, or strong response in most patients,” said Dr. Pfeiffer.

 “It’s not a silver bullet. But when we see these patients in our clinic, who have been through every treatment available and nothing has worked, to have even a quarter achieve a significant measurable response is very good. We routinely get thanked for making a difference in their lives.” 

Complex mental health needs 

The veterans involved in the study had experienced severe depression that proved resistant to multiple treatments. 

Dr. Hosanagar noted that the impact of IV ketamine is especially significant given that treatment resistant depression was not the only mental health condition the veterans were grappling with. 

In addition to severe depression, 70% of the participants had a diagnosis of post-traumatic stress disorder (PTSD), 50% had an anxiety disorder, 27% had a diagnosis of alcohol use disorder, and 27% had a substance use disorder diagnosis. 

“The chronic nature of their conditions is not something ketamine will magically reverse, but when they do respond and feel better, and don’t have to wait as long to see an impact as they do with a traditional antidepressant, it instills a sense of hope,” said Dr. Hosanagar.  

Extended treatment 

The research team analyzed data from the VA’s national patient record system to conduct their analysis, examining the effects of ketamine infusions over a 12-month period following the initial treatment. 

On average, patients underwent 18 infusions, indicating a sustained engagement with the treatment protocol. This extended treatment course highlights the potential for ketamine to offer lasting benefits, with many patients continuing to receive infusions every few weeks for months on end.

Broader implications 

The implications extend far beyond the individual success stories. The study provides a crucial dataset that could inform future protocols for the use of IV ketamine in VA hospitals and beyond, potentially revolutionizing the treatment landscape for depression. 

The researchers are optimistic about ketamine’s role in treating treatment-resistant depression, viewing it as part of a broader, evolving strategy that includes other interventions such as rTMS and ECT.

“It’s important to remember that ketamine is relatively new as a treatment, and there are multiple ways it can be delivered,” said Pfeiffer. “I think we’re in for an interesting decade of a changing landscape for care of treatment resistant depression.”

The study is published in the Journal of Clinical Psychiatry

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