Clinical Depression: Symptoms and Treatment
Time 2021-11-01 07:07:03Web Name: Clinical Depression: Symptoms and Treatment
WebSite: http://depressivedisorder.blogspot.com
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Depression,Clinical,Symptoms,Treatment,and,Description:
keywords: description:If youve heard of ketamine, its probably for itshistory of abuse as a club drug. But it has a different historical background. Ketaminegot its start as an anesthesia medicine in the 1960s. It was used on thebattlefields of the Vietnam War.
Ketamine was approved by the US Food and DrugAdministration (FDA) in 1970 as an anesthetic and safe alternative tophencyclidine. The therapeutic benefits of ketamine as an antidepressant wereexplored years later because of a stigma on from its widespread recreationaluse during the late 1960s and 1970s, and this agent was initially onlyadministered intravenously.
Now this medication is gaining ground as a promisingtreatment for some cases of major depression, which is the leading cause ofdisability worldwide. In the US, recent estimates show 16 million adults had anepisode of major depression in the course of a year. Suicide rates rosesubstantially between 1999 and 2016, increasing by more than 30% in 25 states.Because of its rapid action, ketamine could have a role to play in helping toprevent suicide.
Why is ketamineexciting for treating depression?
If a person responds to ketamine, it can rapidly reducesuicidality (life-threatening thoughts and acts) and relieve other serioussymptoms of depression. Ketamine also can be effective for treating depressioncombined with anxiety.
Other treatments for suicidal thoughts and depressionoften take weeks or even months to take effect, and some people need to tryseveral medications or approaches to gain relief. This is true for talktherapies, antidepressant medicines, transcranial magnetic stimulation (TMS),and electroconvulsive therapy (ECT), which is currently the most effectivetreatment for major depression that fails to respond to other therapies.
Are theredifferent types of ketamine?
Two main types of ketamine are used to treat majordepression that hasnt responded to two or more medications(treatment-resistant depression).
Racemic ketamine, which is most often given as aninfusion into the bloodstream. This is sometimes called intravenous, or IV,ketamine. It is a mixture of two mirror-image molecules: R and S ketamine.While it was approved decades ago as an anesthetic by the FDA, it is usedoff-label to treat depression.
Esketamine (Spravato), resently FDA approved,is given as a nasal spray. It uses only the S molecule.
Thus far, most research has been on ketamine infusions.
The two forms of ketamine interact differently withreceptors in the brain. The delivery of ketamine and the type given affect drugeffectiveness and side effects. We dont yet know which type is more effectiveor how much side effects may differ. Further research comparing effectivenessand side effects is needed.
How does ketaminework?
Its not entirely clear how ketamine works. Because itexerts an antidepressant effect through a new mechanism, ketamine may be ableto help people successfully manage depression when other treatments have notworked.
One likely target for ketamine is NMDA receptors in thebrain. By binding to these receptors, ketamine appears to increase the amountof a neurotransmitter called glutamate in the spaces between neurons. Glutamatethen activates connections in another receptor, called the AMPA receptor.Together, the initial blockade of NMDA receptors and activation of AMPAreceptors lead to the release of other molecules that help neurons communicatewith each other along new pathways. Known as synaptogenesis, this processlikely affects mood, thought patterns, and cognition.
Ketamine also may influence depression in other ways. Forexample, it might reduce signals involved in inflammation, which has beenlinked to mood disorders, or facilitate communication within specific areas inthe brain. Most likely, ketamine works in several ways at the same time, manyof which are being studied.
Ketamine vs. SSRIs
In many cases, the traditional medications prescribed fordepression are either not fast-acting enough or effective enough. For somepatients, Ketamine can become an effective alternative treatment approach.
It works differently from an SSRI such as Lexapro orZoloft. The classical shorthandexplanation for how SSRIs work is the chemical imbalance theory. There is adeficit of serotonin, and SSRIs increase serotonin levels. That was neverreally true. Since depression is linked to the build-up of proteins in thebrain, ketamine can repair damage to the brain that are the result of long-termstress hormones. The bodys response to stress spills cortisol and otherhormones in the brain and they damage it in the process. Ketamine is thought tohave much more rapid effects on increasing brain plasticity.
What are thepossible side effects of ketamine?
All drugs have side effects. When someone is suicidal orseverely depressed, possible benefits may outweigh possible risks.
Ketamine given by infusion may cause:
high blood pressure
nausea and vomiting
perceptual disturbances (time appearing to speedup or slow down; colors, textures, and noises that seem especially stimulating;blurry vision)
dissociation (sometimes called out-of-bodyexperiences); rarely, a person may feel as if they are looking down on theirbody, for example.
Generally, any changes in perception or dissociation aremost noticeable during the first infusion and end very quickly afterward.
Esketamine nasal spray may cause the same side effects.However, the timing and intensity of those effects is different.
Long-term or frequent use of ketamine may have additionalside effects. More research on this is needed.
What else shouldyou know about ketamine?
A much lower dose of ketamine is given for depressioncompared with the dose necessary for anesthesia.
Like opioids, ketamine has addictive properties. Itsimportant to understand this when weighing risks and benefits. If you have ahistory of substance abuse such as alcohol or drugs its especiallyimportant for you and your doctor to consider whether ketamine is a good optionfor you.
When IV (racemic) ketamine works, people usually respondto it within one to three infusions. If a person has no response at all,further infusions are unlikely to help. Instead, its probably best to tryother treatments for depression.
People who experience some relief from depression withinone to three ketamine treatments are probably likely to extend these positiveeffects if the treatment is repeated several more times. The subsequentsessions may help prolong the effects of ketamine, rather than achievingfurther dramatic relief of symptoms. There are no standard guidelines for this.Many studies offer eight treatments initially (acute phase). After this,patient and doctor decide whether to taper or stop ketamine treatments, orcontinue treatments at longer intervals.
Cost of Ketamine
Unfortunately, ketamine is not yet usually covered byinsurance it may cost you $300 to $450 per treatment. Hopefully, thewidespread recognition is not far ahead, and the ketamine treatment will getstandard coverage among major insurance companies soon.
FDA Approved?
The Food and Drug Administration has approved a variantof the anesthetic and party drug ketamine for suicidal patients with majordepression.
The drug is a nasal spray called Spravato and it containsesketamine, a chemical cousin of ketamine.
In 2019, the FDA approved Spravato for patients withmajor depressive disorder who hadn't responded to other treatments. In 2020,the agency has added patients who are having suicidal thoughts or have recentlyattempted to harm themselves or take their own lives.
"Spravato is the first approved antidepressantmedication that's been able to demonstrate a reduction in symptoms of majordepressive disorder within 24 hours after the first dose," says Dr.Michelle Kramer, a psychiatrist and vice president of U.S. neuroscience,medical affairs at Janssen Pharmaceuticals, which makes the drug. Janssen ispart of Johnson Johnson.
The drug's quick action is potentially important forsuicidal patients because "existing drugs typically can take weeks orlonger before you really get noticeable clinical benefit," says Dr. GerardSanacora, a professor of psychiatry at Yale University and director of Yale'sdepression research program. He was involved in the studies leading to the FDAapproval and has consulted for Janssen.
Sources andAdditional Information:
https://www.health.harvard.edu/blog/ketamine-for-major-depression-new-tool-new-questions-2019052216673
https://www.webmd.com/depression/features/what-does-ketamine-do-your-brain
https://www.psycom.net/ketamine-depression
https://www.psychiatryadvisor.com/home/depression-advisor/ketamine-and-future-depression-treatments/
https://www.npr.org/sections/health-shots/2020/08/07/900272454/nasal-spray-is-a-new-antidepressant-option-for-people-at-high-risk-of-suicide
About MeMichael PekkerView my complete profile
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