Ketamine infusions: a breakthrough treatment for some patients with depression

Ketamine is an illegal party drug. But it’s now getting attention as a promising new treatment for depression.

Many patients with severe depression don’t respond to conventional treatments, such as antidepressants and therapy. Recently, ketamine, once used primarily as an anaesthetic and later as an illegal recreational party drug, has become a promising treatment for people living with treatment-resistant depression, chronic pain, suicidal ideation, and mood disorders.

Carole* (name changed for privacy), lives with bipolar disorder. During a recent stay at a mental health facility her psychiatrist recommended a ketamine infusion treatment for a severe, treatment-resistant mixed episode. “He explained that ketamine treatment was still in an experimental phase but was worth trying – particularly because I could be monitored closely as an inpatient,” she says. The 40-minute treatment took place in a darkened room with calming music as a nurse administered ketamine via an injection into her shoulder.

“Within seconds, I felt detached, euphoric, and relieved – as if my chest-crushing anxiety was finally breaking apart, replaced by vivid, emotional visions. I felt a bit shaky and sleepy afterwards and napped for a couple of hours. But the relief was massive. I had five more inpatient treatments. Each one felt a bit milder, and the immediate effects wore off quicker. But the overall relief was immense and lasted for months.”

How ketamine works on the brain

Dr Thabo Mogotlane, a specialist psychiatrist at Mediclinic Legae Mental Health Services, explains that traditional antidepressants work by affecting brain chemicals like serotonin, norepinephrine, or dopamine. Ketamine, however, works on a different neurotransmitter system, known as glutamate.

“Ketamine blocks N-methyl-D-aspartate (NMDA) receptors in the brain, which are involved in learning, memory, and neuroplasticity – in other words, your brain’s ability to change and adapt by forming new connections.” he explains. “By inhibiting NMDA receptors on certain neurons, small doses of ketamine cause a surge in glutamate, the brain’s primary excitatory neurotransmitter.” Glutamate helps your brain with learning, memory, mood, and handling information.

Experts believe a series of ketamine infusions can help build new pathways between brain cells damaged by chronic mood disorders. These infusions can even promote the regrowth of nerve fibres.  “When someone feels stressed or depressed for a long time, the connections between their brain cells can weaken,” Dr Mogotlane adds. “Ketamine seems to help rebuild these important connections.”

Also, unlike regular antidepressants that take weeks to work, ketamine can ease depression in hours or days. Some studies show it can quickly reduce suicidal thoughts and may save lives during a severe crisis.

Is ketamine for you?

In South Africa, doctors can legally prescribe ketamine for off-label use. This means that when a medication is used in a way not officially approved, like for a different condition or dosage. It is used in psychiatry when other treatments don’t work well.

The recommended method for therapeutic ketamine is via intravenous infusion under strict medical supervision. Patients stay awake throughout the treatment, and a healthcare professional needs to monitor their vital signs.

“A typical treatment protocol involves a series of sessions over several weeks, followed by maintenance treatments as needed,” says Dr Mogotlane. “Many patients require ongoing sessions to maintain benefits, and ketamine works best as part of a comprehensive treatment plan that may include traditional antidepressants, psychotherapy, and lifestyle modifications. It’s important to view ketamine as a treatment option rather than a cure.”

Patients with a history of uncontrolled hypertension, certain heart conditions, psychosis, or substance abuse issues might not be good candidates for ketamine therapies.

Even if you don’t have these issues, your doctor might explain that ketamine isn’t right for you because of your medical history, medications you take, or other reasons. They will want to ensure the treatment is safe and the best option for you.

If you feel you need support for your mental health, contact a doctor at www.mediclinic.co.za