Anesthesiologist opens up on ketamine for depression and anxiety

Dr. Carlos de la Hoz

Physicians, psychotherapists and other health care professionals are collaborating to pioneer strategies to use ketamine to treat mental health disorders, PTSD and chronic pain. One such individual is Dr. Carlos De La Hoz, a triple board-certified anesthesiologist, regenerative medicine and pain-management doctor of the Neomedicine Institute (Doral, Florida). 

In recent years, the dissociative anesthetic ketamine has received renewed attention for its potential to treat mood disorders. In small clinical trials, infusions of the drug have led to rapid improvements in mood and reduced suicidality. Ketamine also appears to hold promise for alcohol use disorder. 

Prescribing generic ketamine for depression and other mood disorders, however, remains an off-label use of the drug. However, in 2019, Johnson & Johnson (NYSE:JNJ) won FDA approval for Spravato (S-ketamine), a stereoisome…

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How effective is ketamine for depression? 

[Image by Lucija Rasonja from Pixabay]

First synthesized in 1962, the dissociative anesthetic ketamine is rapidly growing in popularity for its off-label use in treating depression and mood disorders. In recent years, hundreds of clinics across the U.S. have begun offering ketamine for depression, anxiety and other mood disorders.  

The surge in interest has also attracted startups such as Mindbloom and Field Trip Health. At the same time, Janssen (NYSE:JNJ) scored FDA approval for the ketamine enantiomer Spravato (esketamine) for depression in 2019. 

Impressive but limited data

While evidence is building that indicates that ketamine is effective against depression, the level of evidence is frequently limited to small clinical trials, case reports and anecdotes. “It’s really difficult to tease apart what’s happening in these [ketamine] studies because there’s no standard protocol,&…

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Ketamine for depression: Is disassociation really necessary? 

[Image courtesy of PubChem]

Ketamine has emerged as a quick-acting antidepressant in recent years. While use of the dissociative anesthetic for depression has exploded, hurdles remain.

A single ketamine infusion can cost $400 or more in the U.S. Ketamine can also cause significant transient increases in blood pressure.

Furthermore, higher doses of the drug can lead to pronounced states of disassociation, which can induce anxiety in some individuals. Doctors generally recommend that patients receiving ketamine avoid driving or operating machinery for some time following a treatment session.

Whether ketamine’s dissociative side effects are necessary for its antidepressant effects remains unclear.

Dissociating from dissociative side effects

“The dissociative side effects have had a negative impact on the uptake of this [ketamine-based] treatment approach,” said Dr. Hans Erikss…

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