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Sober Nation

Putting Recovery On The Map

04-17-19 | By

Am I Still Sober If I Use Ketamine For Depression?

Recently, Ketamine has been making headlines left and right. In March, the FDA approved an anti-depressant based on ketamine for the first time, called Spravato (the generic name esketamine) which may be one of the biggest breakthroughs to treating severe depression in years. So, while many who are sober have come to find ketamine as a mind-altering drug, the question is, if other co-occurring disorders present themselves – is this new drug okay to take?

The FDA panel voted 14-2 in favor of Johnson & Johnson’s drug esketamine, a treatment developed to treat major depression in patients who have not benefited from at least two different therapies.

Ketamine In The Brain

Introduced in the 1960’s, Ketamine has been used widely in the medical community for pain management, anesthesia, and as an animal tranquilizer. It then became known as a party drug – often referred to as “K,” “Special K,” or “Vitamin K,” which in high doses causes user to hallucinate, and often reduces physical sensations and induce temporary paralysis, so the user is awake but unable to move his limbs or speak – often referred to as a “K-Hole.”

In 1999, the federal government classified ketamine as a Schedule III controlled substance to halt its recreational use, however in the research aspect of things, the drug continued to grow.

However, in medical practices, doctors, dentists, and psychiatrists prescribe ketamine to help their patients achieve a variety of different health goals. Doctors often use ketamine in FDA approved situations such as procedures involving cardiac catheterization, orthopedics, skin grafting, or diagnostics involving the eye, ear, nose, and throat. Surgical dentists may also use ketamine as an anesthesia during tooth extractions.

Though, as the drug continues to make headlines, scientists are now beginning to find how ketamine works in the brain. The drug appeared to rapidly improve functioning of certain brain circuits involved in mood and regulating emotions and it didn’t take long to see the effects. The scientists reported seeing behavioral changes in as little as three hours, while changes in the brain kicked in between 12 to 24 hours after treatment, where it the drug began to restore faulty connections between cells in these circuits.

“Ketamine has a bit of a sordid past, but it is potentially one of the best interventions that we will have in the future for major depression,” said Dr. Darrin D’Agostino, executive dean and vice president of health affairs for Kansas City University of Medicine and Bio sciences.

“Unlike most of our current medications that we are currently using now, it works directly on one of the neurotransmitters and the receptors for those neurotransmitters to make connections in the brain much faster than our traditional medicines,” D’Agostino said. “We can actually use it for people that are in crisis, people that are suicidal, the effects seem to be dramatic.”

As a street drug, ketamine creates these dissociations and euphorias, but for those with treatment resistant depression, prescribed ketamine has proved to relieve mood problems within hours or sometimes moments for about 85% of those treated. While conventional anti-depressants can take several weeks to take effect, studies have shown that ketamine often improves depression symptoms almost immediately.

The Controversy

While many argue that Ketamine has been classified as a schedule III addictive drug, others like Dr. Lee Hoffer, at Case Western Reserve University is an anthropologist who has studied the behavior or drug and alcohol users for years. He argues that whereas a person can take heroin each day and function, ketamine is disruptive, causing major dissociative effects. He states that there’s no withdrawal symptom associated with the drug – which comes as a benefit to those prescribing it. Unlike street drugs, its appeal is limited and its addiction liability is comparatively low.

However, this does not mean that ketamine or Spravato is safe. Its access will be restricted and use monitored by a physician,  and the manufacturer is placing important restrictions on the drug, as it will not be available at local pharmacies and never for take-home use. A person receiving the treatment will be under observation and care of a health professional trained in the therapy. The drug will be given in an office or approved health center, and the patient will not be allowed to drive until the day after treatment.

Additionally, given its short effect time, professionals report that the benefits will outweigh the risks of the drug for the treatment of depression. While any new drug on the market, the FDA will continue to monitor the outcomes and effects the drug has on each person.

So if someone who once had a substance abuse problem considers the option of the new drug, should they consider themselves sober? In this case, it’s best to consult your physician, look at your motives, and speak to your family and supports, as Spravato is currently only being prescribed for those who have not benefitted from at least two other therapies. For those with severe depression, turning it around may not be a phenomenon, it can certainly feel like one for the person who is experiencing the symptoms of it.

“Outside of the clinic, ketamine can cause tragedies, but in the right hands, it is a miracle,” says John Abenstein, MD, president of the American Society of Anesthesiologists.

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