Treatment-resistant depression is a debilitating mental health condition that affects millions of people worldwide.
With the option of getting a series of six ketamine infusions, or weekly Spravato nasal sprays, patients with depression and bipolar depression are beginning to wonder if they should choose ketamine over treatments such as ECT (Electroconvulsive Therapy), offered by interventional psychiatry facilities.
Despite the availability of various treatment options, a significant number of individuals with depression do not respond adequately to traditional antidepressant medications. Medications such as Lexapro, Prozac, Paxil, and Zoloft, and other older antidepressants fail to improve the patient’s mood, and they fail to improve functioning with respect to activities of daily living.
If a patient has recently tried an antidepressant medication without relief, and then they try another depression treatment with a different antidepressant, they may have the diagnosis of treatment-resistant major depression. The antidepressant effect of SSRIs (selective serotonin reuptake inhibitors) and other antidepressants may not be effective at all for some people.
Having a depressive episode while taking an antidepressant drug can be disheartening. We expect medical therapies to help us to feel better, but experts are now discovering that traditional antidepressants are not as effective as previously thought, and they carry a significant risk of side effects and adverse reactions.
When traditional antidepressants fail, there are several alternative therapies available, including ketamine infusion, Spravato nasal spray (Esketamine), and ECT. By understanding the mechanisms of action and effectiveness of these treatments, individuals with treatment-resistant depression can make informed decisions about their mental health care.
Understanding Treatment-Resistant Depression
Treatment-resistant depression is characterized by a lack of response to multiple antidepressant medications or therapies. Symptoms of treatment-resistant depression are similar to those of major depressive disorder and may include persistent sadness, loss of interest in activities, changes in appetite and sleep patterns, difficulty concentrating, and thoughts of self-harm or suicide.
Suicidal ideation is of particular concern because there may be a real risk of the patient progressing to active suicidal thoughts and suicide attempts. Treatment-resistant major depression must be taken seriously.
The impact of treatment-resistant depression on individuals and society is significant, as it can lead to decreased quality of life, impaired functioning, increased healthcare costs, and higher rates of disability. Fortunately, patients with treatment resistant depression have more options available to treat their depression symptoms than ever before.
Ketamine Vs ECT
Ketamine is a dissociative anesthetic that has gained attention in recent years for its potential as a rapid-acting antidepressant. It was originally developed as an anesthetic in the 1960s and has since been used for various medical purposes. Ketamine is available as IV ketamine infusions, intranasal esketamine, and oral ketamine sublingual compounds.
Ketamine therapy with intravenous infusion is being used to treat a wide variety of conditions, including pain syndromes such as migraines, fibromyalgia, CRPS (chronic regional pain syndrome), chronic Lyme disease pain, and neuropathic pain. Intravenous ketamine is also used to treat depression, anxiety, OCD (obsessive compulsive disorder), PTSD (post-traumatic stress disorder), addiction, bipolar disorder, and more.
Electroconvulsive therapy (ECT), on the other hand, is a procedure that involves inducing seizures in the brain through electrical stimulation. It has been used for decades as a treatment for severe depression that does not respond to other interventions.
Prestigious institutions, such as Mclean Hospital, the psychiatric institution of Harvard Medical School, have long relied on ECT, but are now turning to treatments such as ketamine infusion and Spravato for treatment resistant depression. ECT may still be useful for some cases, but many patients who would have previously been offered ECT are having excellent results with ketamine therapy.
How Ketamine and Esketamine Nasal Spray Work to Treat Depression
Ketamine and its derivative esketamine work by targeting the glutamate system in the brain. Glutamate is an excitatory neurotransmitter that plays a role in mood regulation. It is believed that ketamine’s antidepressant effects are due to its ability to increase synaptic connections in the brain, leading to the formation of new neural pathways.
Clinical studies have shown that ketamine and esketamine can produce rapid and significant improvements in depressive symptoms, often within hours or days of administration. The treatment response, particularly for ketamine infusion therapy, can be particularly long-lasting.
How ECT Works to Treat Depression
ECT works by inducing a controlled seizure in the brain through electrical stimulation. The exact mechanism of action is not fully understood, but it is believed to involve changes in neurotransmitter levels and increased neuroplasticity.
ECT is typically administered in a series of sessions over several weeks, with the number of treatments varying depending on the individual’s response. Clinical studies have consistently shown that ECT is highly effective in treating treatment-resistant depression, with response rates ranging from 50% to 80%.
Unfortunately, while ECT has been considered the gold standard for treating treatment-resistant depression for many years, the risk of side effects and adverse reactions is concerning. Additionally, many individuals would prefer to avoid electrical currents delivered through their skull with the intention of causing seizures.
The Effectiveness of Ketamine vs Esketamine in Treating Treatment-Resistant Depression
Several clinical studies have compared the effectiveness of ketamine and esketamine in treating treatment-resistant depression. Overall, both substances have been shown to produce rapid and significant improvements in depressive symptoms. However, there are some differences between the two.
For example, ketamine is typically administered intravenously, while esketamine is available as a nasal spray. Additionally, esketamine has been approved by the U.S. Food and Drug Administration (FDA) for use in treatment-resistant depression, while ketamine is often used off-label.
Esketamine, available under the brand name Spravato, is delivered as a weekly nasal spray. Ketamine infusions are usually given in a series of six to eight infusions over a period of weeks. Additional infusions may be given periodically, as needed.
Ketamine treatment, whether administered intravenously or as a nasal spray, can have side effects. Common side effects include dissociation, dizziness, nausea, and increased blood pressure and heart rate. These side effects are usually temporary and resolve shortly after the treatment.
The Effectiveness of ECT in Treating Treatment-Resistant Depression
ECT has been widely studied and has consistently shown high rates of effectiveness in treating treatment-resistant depression. It is considered one of the most effective treatments available for severe depression that does not respond to other interventions.
However, ECT does come with some potentially serious side effects and risks. Common side effects for ECT patients include temporary memory loss and confusion immediately following the procedure. These effects typically resolve within a few hours or days.
There is also a small risk of more serious complications, such as cardiovascular problems or fractures, although these are rare. It is important to discuss the potential risks and benefits of ECT with a healthcare professional before undergoing the treatment.
Cost Comparison of Ketamine, Esketamine, and ECT Treatment
Esketamine treatment may be covered by insurance for individuals who meet certain criteria. While the criteria for Spravato approval by health insurance may seem complex, the expert staff at The Mood Center will help you get approved, making the process easy and painless.
ECT treatment is typically more expensive than ketamine or esketamine treatment due to the need for multiple sessions and anesthesia, though it is often covered by insurance. Ketamine infusions are not currently covered by health insurance, but they are surprisingly affordable at many ketamine clinics.
Availability of Ketamine, Esketamine, and ECT Treatment
The availability of ketamine and esketamine treatment can vary depending on the location and healthcare provider. Ketamine treatment is often offered in specialized clinics or infusion centers, while esketamine treatment may be available in certain psychiatric clinics or hospitals.
Fortunately, for residents of Annapolis, the Washington Metropolitan Area, and other surrounding communities, The Mood Center offers both ketamine and Spravato nasal spray therapies.
ECT treatment can be found in many psychiatric hospitals or clinics. However, geographic and logistical considerations may still impact access to these treatments, particularly in rural or underserved areas.
Choosing the Right Treatment for Your Depression
When considering treatment options for treatment-resistant depression, it is important to consult with a healthcare professional who can provide personalized recommendations based on your individual needs and circumstances. Factors to consider when choosing a treatment option include the severity of your depression, previous treatment history, potential side effects and risks, cost, and accessibility.
Ketamine, esketamine, and ECT are alternative treatment options for individuals with treatment-resistant depression. These treatments have shown promise in rapidly improving depressive symptoms in individuals who do not respond to traditional therapies. However, it is important to weigh the potential benefits against the risks and consider individual factors when choosing a treatment option.
Considering the safety of ketamine and esketamine, individuals may want to consider trying these therapies before committing to ECT for treatment-resistant depression. We believe that ketamine infusion and Spravato are becoming the gold standard for medication-assisted treatment of treatment-resistant depression.