Depression is the leading cause of disability world-wide. In the United States, about 7.1% of adults experience at least one major depressive episode, and suicide rates have been steadily rising over the past 20 years. Given the recent outbreak of the coronavirus pandemic, anxiety levels are at an all-time high, the risk of suicide is elevated, and mental health concerns must be taken seriously. Typical treatment plans for major depression include antidepressant medications and psychotherapy, both of which can take several weeks before becoming effective. This can be extremely frustrating for patients. If these traditional approaches are not helpful in reducing a patient’s depressive symptoms, more aggressive treatment options such as electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), or ketamine infusion may be recommended.

For patients suffering from treatment-resistant unipolar major depression, ketamine infusions offer a modern approach to alleviating symptoms of depression rapidly and transiently. Through activation of different receptors in the brain, including the opioid receptor, NMDA receptor, and AMPA receptor, ketamine aids neurons in communicating along new pathways — a process called synaptogenesis that is thought to affect cognition, mood, and patterns of thinking. Patients experiencing more severe cases of depression at baseline are more likely to respond positively to ketamine infusion. Of all the treatments for depression, ketamine infusion produces the largest margins of improvement in depressive symptoms after two weeks of treatment. Normally, patients respond after just one infusion. If not, most patients respond by the third infusion.

Like all drugs, ketamine infusion is associated with various side effects. The most common short-term side effects of intravenous ketamine infusion include dissociation, hallucination, elevated blood pressure, anxiety, headache, and nausea. Although rare, potential long-term side effects include neurotoxicity, bladder dysfunction, and liver damage. Additionally, ketamine is liable to abuse and addiction. Usually, any adverse side effects patients experience resolve relatively quickly post-infusion, peaking around 40-60 minutes after starting the infusion and concluding within 4 hours. Some patients describe receiving a ketamine infusion as a pleasant, dream-like experience. Others comment on ketamine’s unique ability to rewire the brain, replacing any negative thinking with a positive outlook.

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