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What is Ketamine?
Ketamine is dissociative anesthetic and pain relieving medicine that was developed in the 1962 by Dr. Calvin Stevens at Wayne State University in Michigan. It has been used as an anesthetic agent by anesthesiologists and emergency physicians for operations and procedural sedation since FDA approval in 1970. Ketamine is listed on the World Health Organization’s (WHO) top 100 essential medicines in a hospital. Most recently, ketamine’s unique properties has been scientifically proven for its effectiveness in various mood & pain disorders.
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 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 hyperalgesia or neuropathic pain, ketamine can provide immediate and dramatic relief.
Inclusion criteria
Depression
Anxiety
PTSD
OCD
Fibromyalgia
Neuropathic pain
CRPS/RSD
Chronic Migraines
Bipolar Depression
Post-Partum Depression
Exclusion Criteria
Uncontrolled high blood pressure
Unstable heart disease (arrhythmias, congestive heart failure, chest pain)
Untreated thyroid disease
Untreated glaucoma
Untreated elevated intracranial pressures
Active substance abuse
Active manic phase of bipolar disorder
Active delusions and hallucination symptoms
Family or personal history of schizophrenia
THE RESEARCH
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 robust effectiveness in using ketamine for depression and a recent publication in the New England Journal of Medicine shows that it is as effective as electroconvulsive therapy (ECT). 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.