Growing Awareness for Ketamine Treatment in Depression and Anxiety

May 6, 2014
Steven P. Levine, MD

When I first considered intravenous ketamine to treat severely treatment-resistant depression 4 years ago, I was in a scary, lonely place where I received a lot of skeptical questions and funny looks accompanying chirping crickets.

When I first considered intravenous (IV) ketamine to treat severely treatment-resistant depression (TRD) 4 years ago, I was in a scary, lonely place where I received a lot of skeptical questions and funny looks accompanying chirping crickets.

As I administered the first ketamine infusion, I bit down on the proverbial block of wood. Although the risks were unknown regarding long-term safety and my professional reputation, I decided the treatment was worth it because it just made sense.

Since then, awareness has grown not through expensive multimedia campaigns and samples delivered to physician offices, but through evidence of undeniably powerful results. The data supporting IV ketamine have always been intriguing, but just in the past year, a trove of studies have been published that add to the excitement surrounding the drug’s safety and rapid efficacy, as well as expand the potential scope of its application.

Some of the most important new studies include:

  • The largest-to-date randomized controlled trial (RCT) of IV ketamine for TRD, which was also the first to use an active comparator group who received midazolam.1
  • An RCT that found a single dose of IV ketamine rapidly reduces symptoms of chronic posttraumatic stress disorder (PTSD).2
  • A positive proof-of-concept RCT of a single dose of IV ketamine rapidly reducing symptoms of obsessive-compulsive disorder (OCD).3
  • An RCT of IV ketamine showing rapid reduction of suicidal cognitions.4
  • The first published RCT of intranasal ketamine for depression in adults.5

As positive studies on IV ketamine continue to roll out, at least 20 private practitioners across the country are now offering this treatment, in addition to a handful of some of the most respected teaching hospitals on an inpatient or outpatient basis.

I used to get a call every week or so from a physician interested in the subject, but now I receive calls almost daily. Initially, most of my ketamine patients were self-referred, as they would find me online in the course of their search for other options after being let down by typical antidepressant treatment. Now, almost all of my patients are referred directly by their physician.

Despite my long-standing enthusiasm for ketamine’s potential, I have devoted relatively little energy to this part of my practice. However, I have decided it is now time for me to put my money where my mouth is.

This June, I will open the doors of the Ketamine Treatment Centers of Princeton, LLC, with an anesthesiologist partner. The center aims to increase accessibility for a wider scope of patients with mood, anxiety, and pain disorders, using the protocol I developed and refined based on my experience in treating hundreds of patients. The time to raise expectations for rapid and well-tolerated treatment has finally come.

References

1. Murrough JW, et al. Antidepressant efficacy of ketamine in treatment-resistant major depression: a two-site randomized controlled trial. Am J Psychiatry. 2013 Oct 1;170(10):1134-42. http://www.ncbi.nlm.nih.gov/pubmed/23982301.

2. Feder A, et al. Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: A randomized clinical trial. JAMA Psychiatry. 2014 Apr 16.

http://www.ncbi.nlm.nih.gov/pubmed/24740528.

3. Rodriguez Cl, et al, Randomized controlled crossover trial of ketamine in obsessive-compulsive disorder: proof-of-concept. Neuropsychopharmacology. 2013 Nov; 38(12):2475-83. http://www.ncbi.nlm.nih.gov/pubmed/23783065.

4. Price RB, et al. Effects of ketamine on explicit and implicit suicidal cognition: a randomized controlled trial in treatment-resistant depression. Depress Anxiety. 2014 Apr;31(4):335-43. http://www.ncbi.nlm.nih.gov/pubmed/24668760

5. Kyle AB, et al. A randomized controlled trial of intranasal ketamine in major depressive disorder. Biological Psychiatry. 2014 Apr 2;75(8). http://www.biologicalpsychiatryjournal.com/article/S0006-3223(14)00227-3/pdf.

About the Author

Steven P. Levine, MD, is a board-certified psychiatrist and therapist. He received his psychiatry training at New York Presbyterian Hospital and Memorial Sloan Kettering Cancer Center and currently practices in Princeton, NJ.