Nasal Ketamine Treatment for Patients Unresponsive to Other Medications

Nasal ketamine treatment is a new medication used to help patients dealing with symptoms of clinical depression.

Antidepressants are the standard medication, but sometimes the medication does not always work. Patients would often find it hard to shake off the feeling of hopelessness, energy loss, sadness, lack of sleep, loss of appetite and sleep changes.

This new medication may be effective for patients who are battling treatment-resistant depression. It is called ketamine and was approved by the FDA recently.

What is nasal ketamine treatment?

Nasal ketamine treatment is a type of ketamine, which is a common drug that has been used as anesthesia for many years.

Doctors have used ketamine for several years in minimal doses in IV form for a patient with treatment-resistant depression. However, as a generic drug, it has not been subjected to the FDA’s review process.

It is a controlled substance often abused as a recreational drug, often called "Special K." It also causes hallucination and feelings of dissociate. This means that the new nasal ketamine treatment will only be provided in a physician’s office or in the hospital. It will be administered as nasal puffs.

The patient will visit their doctor once or twice a week to get nasal sprays of a dose of ketamine. Since it may cause disorientation or confusion soon afterward, the patient will remain in the doctor’s office for about two hours. They will be told not to drive, operate machinery or perform tasks that demand mental effort for the remainder of the day.

Why it sounds promising

One good thing about the new drug is that the effects are quick. The patient may experience relief from their symptoms in only a few hours. That could last for many days. Many oral antidepressants usually take weeks before their effects are noticeable.

Nasal ketamine treatment works differently from other depression meds. Unlike most antidepressants that work primarily on the norepinephrine, serotonin or dopamine systems, ketamine has a significant impact on glutamate, a different neurotransmitter that is more predominant in the brain.

The drawbacks

Aside from the potential side effects, there are certain drawbacks. Although it has been applied safely as a temporary anesthetic and in small doses as a temporary antidepressant, doctors are not sure if the treatment is safe and effective for long-term use.

The drug has effects on a major neurochemical in the brain. Interfering with it over a long period could have some unwanted impact that doctors are not sure of. Also, because it is addictive, people can overuse or misuse it.

It is also hard to tell if the drug will be effective for everyone with drug-resistant depression. Like many other antidepressants, there is always the potential that the symptoms could worsen.

Final note

Doctors hope that nasal ketamine treatment would be an easier option when a quick result is necessary. For patients who are not responsive to medications, ketamine will serve as the treatment option that does not require anesthesia and will not cause memory impairment.

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Don A. DuBose, M.D., M.S.

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