when nothing else is working
Do you have severe, treatment-resistant depression? That’s the term to describe when you’ve tried all the anti-depressants on the market (SSRIs or SNRIs) but they’re not helping. Or when you go to therapy sessions for years but feel stuck. It’s a brutal, unrelenting darkness, a persistent sadness, or a sense of hopelessness, that permeates everything you do. Sometimes it feels like numbness or no longer caring about things you used to care about. Treatment-resistant depression can also mean struggling with suicidal thoughts (called ideation) every day.
Ketamine alleviates suicidal thoughts quickly - sometimes in hours. But how?
How does ketamine work for depression?
It turns down the volume on our default thought patterns. The default mode network is the self-referential network; it’s what we’re thinking when we’re not aware we’re thinking. And in a depressed person, that default mode is awful. It focuses on failures, loneliness, rejections, losses, and abandonments. Sometimes after one dose of ketamine, people have a different way of thinking about their lives. They’re disconnected from their inner voices and they’re able to find relief from emotional pain. For people with a traumatic past, ketamine fosters deeper healing. It enables patients to face long-hidden, shameful material because while under its effects, patients are open, unafraid, and undefended.
And what exactly is going on in the brain?
Ketamine reduces activity in the Amygdala - the part of the brain that alerts us to fear. This creates a soothing effect through binding with the Kappa opioid system, and also affects NMDA receptors and 5-HT2A receptors sites. Ketamine triggers the release of glutamate and regenerates neuronal connection, which enables the growth of synapses which have been damaged by chronic stress. These boosted neural circuits regulate stress and mood.
How long do the effects of ketamine for depression work?
After the first session, many patients feel better right away, but studies have shown that the benefits to mood and neurological growth can last up to two weeks after. During these two weeks, there’s an enormous growth of new brain cells, which acts like a reset for your brain. It’s called neuroplasticity, and means that networks that don’t usually communicate with each other start to connect. These new connections allow cognitive shifts to take place.
Although the therapeutic effects are rapid and sometimes notable after just one session, they don’t last. That’s why ketamine is most effective when taken over consecutive doses, as part of a treatment protocol that happens over the course of months.
Does ketamine work for everyone?
Ketamine is a revolutionary treatment for some, and it doesn’t work at all for others. It’s not a miracle cure and its 70% success rate is higher than anti-depressants alone and a bit higher than the success rate of many talk therapies. But it’s most effective as part of Ketamine-Assisted Psychotherapy, or KAP. That’s when ketamine treatment is combined with dedicated psychotherapy sessions for deeper therapy and more frequent breakthroughs. These psychotherapy sessions between medicine sessions - with a therapist - help to catalyze a different mindset.
It’s important to understand KAP isn’t just medication. It’s the therapy and integration sessions that create lasting results. Ketamine offers a compassionate path forward for significant breakthroughs, fostering both practical change and a deeper, more sustained emotional healing.