Thank you again for taking the time out of your busy schedule to review this information. It means a lot and could potentially impact your patients tremendously.
What is Ketamine?
Ketamine is dissociative and pain relieving medicine that was developed in the 1960s as an anesthetic agent. It is used as an anesthetic agent by anesthesiologists and emergency physicians for operations and procedural sedation. Ketamine is the most commonly used drug in the world for sedation because of its safety profile. In developing countries, some doctors do not have the equipment or an anesthesiologist for monitoring patients during surgeries and procedures. Thus, their drug of choice is ketamine. Ketamine protects the patient's ability to spontaneously breathe and maintains blood pressure. Accordingly, ketamine is listed on the World Health Organization’s (WHO) top 100 essential medicines in a hospital.
How does it work?
Ketamine’s mechanism of action is an N-methyl-D-aspartate (NMDA) receptor antagonist, which blocks the action of the glutamate neurotransmitter in the central nervous system. One potential mechanism of ketamine is the increase of BDNF (brain-derived neurotrophic factor) within the synaptic connections allowing the brain cells to have more connections with other neurons.
Chronic depression and stress states are known to diminish the number of neuronal connections. As a metaphor, imagine the branches of a tree in the winter versus the summer. This growth of connections is one way that ketamine works in the brain.
Another hypothesis is that ketamine blocks somatic input from the body, which allows increased communication between the mid-brain and the cerebral cortex. Accordingly, this may allow for further connection between the limbic system (i.e. emotions) and the prefrontal cortex (i.e. higher level thinking) which may help in processing traumatic events.
For neuropathic pain and complex regional pain syndrome (CRPS) hyper-regulation and central sensitization are triggered by stimulation of the N-methyl-D-Aspartate (NMDA) receptors and appears to be the primary neurological processes. Ketamine changes this central pain-processing. In lay language, it’s like hitting the ‘reset’ button and restores normal pain processing. This means that for patients who have opioid-induced hyperalgia or neuropathic pain, ketamine can provide immediate and dramatic relief.
- Treatment-resistant depression
- Severe Anxiety
- Uncontrolled chronic neuropathic pain
- Chronic Migraines
- Substance Use Disorders
- Bipolar Depression
- Post-Partum Depression
- Uncontrolled high blood pressure
- Unstable heart disease (arrhythmias, congestive heart failure, chest pain)
- Untreated thyroid disease
- Active substance abuse
- Active manic phase of bipolar disorder
- Active delusions and hallucination symptoms
- Family or personal history of schizophrenia
The first study was done 18 years ago by Dr. Berman, et al, from Yale University. They did a placebo controlled, double-blinded trial on a small number of depressed patients using IV ketamine. The results showed significant improvements in depressive symptoms. Ever since then, there have been more trials showing positive results.
A recent meta-analysis shows the effectiveness in using ketamine for depression. Additionally, other studies have shown effectiveness of ketamine in the use of PTSD, anxiety, social anxiety disorder, fibromyalgia, and chronic pain. See more news and academic articles HERE.
If you want to refer your patient or have any other questions, please fill out this referral form or contact me directly at: samko@resetketamine or 760-422-5578.