The strongest effect that the studies document is the value of intravenous ketamine therapy for relieving depression.
A reduction in unipolar depression severity occurred within anywhere from 1 to 24 hours, and it lasted for 1–2 weeks. In comparison, oral doses took up to 2 weeks to have an effect.
Bipolar depression relief was also rapid, occurring as quickly as 4 hours after administration and consistently by 24 hours. The full effect lasted for up to 3 days, with some relief still apparent after 7 days.
The studies also support the use of ketamine for treating affective disorders and thoughts of suicide.
Of suicidal ideation, co-author and University of Exeter Ph.D. candidate Ozden Merve Mollaahmetoglu told GMHCN.
“It is really interesting that there is some evidence of an effect on suicidal thoughts independent of depressive symptoms, and it would be great to understand the mechanism of this effect. This finding is important because there is a risk of suicide in several mental health problems, so it would be interesting to see if we could treat suicidal thoughts in other conditions, such as substance use disorders.”
Mollaahmetoglu also noted: “Since the effect of ketamine on suicidal thoughts was short-lived, it would also be important to determine how this can be extended — for instance, in combination with psychotherapy. We also don’t know whether multiple doses of ketamine are more effective than a single dose for reducing suicidal thoughts, as this hasn’t been directly compared.”
Other research found some therapeutic benefit to the use of ketamine for other psychiatric disorders such as “post-traumatic stress disorder, obsessive-compulsive disorder, anxiety, and substance use disorders.” However, write the authors, “the evidence base comprised a small number of mostly nonrandomized trials with often short follow-up periods, therefore requiring corroboration and extension.”Safe in a clinical setting
The study emphasizes the importance of restricting the administration of ketamine to carefully controlled clinical circumstances.
Mollaahmetoglu told GMHCN:
“Ketamine is a very safe drug in a clinical setting. When people are given ketamine, we see mild increases in blood pressure and heart rate, which can be monitored and managed in clinical settings.” She also noted that people who might be at “increased risk of negative psychological reactions to ketamine, like people with a personal or family history of schizophrenia, can be screened out.”
Additionally, in such a setting, “People are provided with preparation and psychological support during and after the ketamine infusions, which likely reduces [the] risk of adverse psychological reactions.”
Finally, it is possible to protect individuals in a clinical setting from accidental injury and physical vulnerability due to ketamine’s dissociative effect. This effect promotes a “reduced awareness of their environment, lack of coordination, inability to communicate, and considerably diminished sensory input.”Ketamine requires caution
Dr. Alan F. Schatzberg, a professor of psychiatry and behavioral sciences at Stanford University, told MNT that “whether, in fact, these drugs are effective enough to be worth it is still unanswered.”
Dr. Schatzberg cautioned, “I haven’t seen enough real data to say that we [have] got a huge winner there.”
His concern is that, “ketamine works through an opioid mechanism, and ketamine in certain forms and in certain situations, it’s highly addictive.”
Dr. Schatzberg also noted the difficulty of conducting unbiased, blind studies of ketamine’s effect on mental health due to the disassociation it produces because “a patient, in fact, has a sense of what drug or placebo they got.” He recalled that in some approved esketamine trials, “they didn’t ask the patients, ‘Hey, do you think you got [the] drug or placebo?’”
“The way the study frames it,” said Dr. Schatzberg, “is positive, positive, positive. But you know, you have to wonder when you’re dealing with something like ketamine.”