Ketamine for Depression
“Why aren’t my anti-depressants working?”
If you’re one of the millions of people that have tried SSRI’s (selective serotonin reuptake inhibitors) for depression and anxiety (brands like Prozac, Lexapro, Zoloft, Celexa, Paxil, and others) and found them ineffective, worry not. You are part of a large club that includes fully half of the human population. Until recently, scientists had no good explanation as to why the drugs are failing half of the time (and eventually stop working a third of time), and no good options for those who continue to suffer with depression. But a major new study has demonstrated that our understanding of how SSRI’s work, when they work, has been wrong all along.
With the rise in popularity of SSRI’s, the scientific establishment became dominated by the “serotonin hypothesis” of depression. This is the latest version of the idea (a rather old one) that depression is caused by an imbalance of particular chemicals in the brain. The problem with this idea is that it could never explain why increasing the amount of serotonin in the brain, which SSRI’s do, has never actually been that effective at curing depression. Lo and behold, a recent review of decades of research published in Molecular Psychiatry found that there is no significant link between serotonin and depression. ‘“Many people take antidepressants because they have been led to believe their depression has a biochemical cause, but this new research suggests this belief is not grounded in evidence,” said Joanna Moncrieff, MD, professor of psychiatry at UCL, and a consultant psychiatrist at North East London NHS Foundation Trust (NELFT) in a statement.’
This new research underscores the need for a new approach to treating depression through medicine.
Ketamine: A new depression treatment
Ketamine is a compound that has been used for decades as an anesthetic. It has been the anasthetic choice for physicians working in high stress environments like combat zones, as well as for children undergoing medical procedures, because it extremely safe to use and includes very low risk of overdose. In recent years, ketamine has begun to be studied and used to treat a variety of mental health conditions, including anxiety, depression and post-traumatic stress disorder (PTSD).
The powerful anti-depressant qualities of ketamine are, at this point, quite well accepted. It has become a common treatment for treatment-resistant depression, those cases of serious, chronic depression that have not yielded to any other intervention. Several studies featuring randomized placebo-controlled trials have established the effectiveness of ketamine at quickly reducing severe depressions symptoms, including for bipolar depression. Amazingly, ketamine has even been shown to reliably and rapidly decrease suicidal thinking, something that no other known drug or intervention is capable of. (Zarate and Niciu, 2015)
Ketamine as a Psychedelic
What is unique about ketamine is that in addition to being a powerful anti-depressant, it also has psychedelic properties. It is an NMDA receptor antagonist, which means it blocks the action of glutamate, a neurotransmitter that is involved in learning and memory. In doing so, ketamine creates an effect in the brain similar to that of the “classical psychedelics - psilocybin, LSD, etc. - significanlty increasing the level of neural connectivity between the different brain structures governing memory, emotion, and information processing. This results in an opening of the window neuroplasticity, a temporary state in which enables reformatting and re-networking of entrenched neural pathways.
In the psychedelic state of mind, the veil between our conscious and unconscious minds is allowed to safely open up. We can see and feel with greater clarity the traumatic events and resultant fixed beliefs that keep us in limiting, defensive and depressive patterns of thought and behavior. With the help of ketamine’s soothing effect on our nervous system, we are enabled to meet this difficult material without needing to shut down, distract, or get over-anxious. Instead, we get to bring curiosity and compassion to these wounds, allowing them to come into the light and be accepted, integrated, or released through emotional or somatic discharge.
Additionally, ketamine enables us to touch into a whole dimension of our being of which most of us are typically unaware - the transpersonal. The transpersonal describes the various ways we feel connected to something larger than our own individual life and ego. The feeling of being “one with the universe,” though it may sound cliche, is a genuine and powerful experience that many people have on psychedelic journeys with ketamine. It is a profoundly anti-depressant experience, because depressive thinking is all about how isolated we feel from everyone and everything, or how wrong and broken we are as individuals. A transpersonal experience disrupts depression by reminding us that we are waves in the great ocean of Being, that we are each a child of nature like any tree or star, that we are right where we belong, no matter how much pain or shame we have endured.
Because ketamine produces this rare openness and flexibility of mind, its potential is amplified when paired with psychotherapy. Ketamine-assisted psychotherapy or KAP, is a new practice which involves taking a dose of ketamine as part of a short or long term course of psychotherapy. A skilled therapist can provide safety and support through the ketamine experience, and importantly, help you process and make sense of the thoughts, images, and memories that came up during the ketamine experience. New insights and experiences take time and attention in order to bring about lasting changes in mood and behavior, and so using ketamine in the context of a therapy relationship enhances the potential of both interventions.