Good to hear from you.
It's no wonder that Ketamine is a potent antidepressant, it's been used as a party drug for decades. It's still used as a pretty potent tranquillizer for horses and big farm animals.
First let me say I'm still new to Ketamine, so anything I write from this point further, may have flaws due to my lack of knowledge about this antidepressant. Luckily, responding, helps me understand it more. :)
Ketamine, from my understanding, works on the brain receptor site NMDA. It has been used and abused in party circuits. Obviously this drug is controversial, since it ranks up with similar controversial drugs such as marijuana and cannabis that have been used by medical doctors to treat patients. There have been studies that support those two compounds for medical help can be beneficial, however their uses can easily be abused.
The mechanisms of action is completely different than that of conventional antidepressants, which is why it's action is almost immediate. It has something to do with the glutamate receptors, I think. The issue is that there is a huge potential for addiction with Ketamine, as a dose generally initiates a feeling of euphoria.
Yes. It seems to work similarly like benzodiazepines, due to its fast acting effect on the glucocorticod receptor site of the brain. Valium (diazepam), klonopin (clonazepam), ativan (lorazepam) and xanax (alprozalam) are probably the most prescribed benzodiazepines to treat mental health disorders, such as generalized anxiety disorder, for fast acting relief. These medications affect benzodiazepines sites. Ketamine would affect a more specific area of the glucocorticod receptors, which would be the NMDA site.
In the near future, I see this only be approved, or used off label, for cases where a patient is extremely agitated or on the verge of self harm. So, I suspect that very few will ever get a prescription for Ketamine. Although, people get prescriptions for morphine and Ritalin, so it's not out of the picture.
I don't think any psychiatrist would prescribe Ketamine, at this point in their practice, since it's still under research. I think it should be prescribed in severe cases, as in for inpatient treatment of patients on the verge of harming themselves.
For the type of people that go to doctors for psychiatric illness, most don't go for the prevention of psychiatric disorders. Usually it's when someone is in a state of panic or deep depression that they choose to seek medical treatment for this medical disorder. By then, the deep depression or high anxiety is fairly high, and the brain is in state of shock, based on how neurotransmitters are not cooperating together.
It's at this stage, that a drug like Ketamine could be helpful. Usually when someone is at the worst stage of their mental illness, the person is at their highest lack of patience to get better. Some would rather die than to feel their mental pain. The use of SSRIs, trycyclics and other psychiatric medications can work, however the problem is the time it takes these medications to make changes in the brain, due to neurogenesis. I think, one of the reasons that psychiatric medications get a bad rap for not being effective, is based on the patient and their lack of patience to let the medication work. Who has three months to wait to get better, while a psychiatric drug takes into effect, not to mention battle more potential problems like side effects? Adults have jobs and families to manage. Since many people don't view mental illness as a medical problem, users don't give psychiatric drugs a fair chance.
Since Ketamine works quickly, patients can feel the positive benefit, without having to wait for an antidepressant to become effective. A doctor could prescribe the antidepressant, and supervise the patient, as the antidepressant becomes effective, and then wean the patient off Ketamine.
Of course, I am not a doctor, and will never prescribe medication, however I've encountered people in the deepest regions of mental illness, due to improper brain functioning. A quick acting medication would help.
This, of course, sets alarm flags already with doctors who have benzophobia to prescribe benzodiazepines, due to patients abusing them. Obvisously, a doctor would only give Ketamine to a specific type of patient, who wouldn't abuse it or sell it off market.
Although it has great efficacy, in the long run it has worse side effects than even MAOIs and the harshest TCAs... I saw a study that showed that some kids who got addicted to it as a party drug and took it for a while ended up losing bladder control. Also, Remeron and some of the TCAs work in as little as two weeks, especially if given in combination with Pindolol, a beta blocker. Most doctors are just oblivious to what their patients are going through and the proper means of treatment.
Now, where there is potential for a great new antidepressant is one that acts on the glutamate receptors without getting you high as a kite or making you pee yourself.
I think every antidepressant affects the glucocorticoid site, just not as quickly as Ketamine would. Antidepressant medications take between six and twelve weeks to become effective. Once stabilized in the brain these medications can then affect the hippocampus, glucocorticoid receptor sites, as well as the limbic structures of the brain's frontal lobes. All of these areas of the brain have an affect on mood disorders. If given the right psychiatric medications, the brain will heal itself by repairing neurons that were previously damaged by prolonged, psychological stress.
I don't think doctors give patients enough background on how antidepressants work, but I guess they don't have time to give crash courses on antidepressant usage and the importance of time. Let alone, who wants to explain neurogenesis, when it's still a new concept that even the psychiatric community has disagreement about? So this affects how patients use their drugs, since they don't understand how they work. Due to their lack of understanding, patients blame the drugs and their doctors for not working, effectively.
Anyway, thank you for giving me time to reflect on this medication. :)