What is Ketamine?
Ketamine was approved by the FDA for use as an anesthetic in 1970 and has now been used safely for decades. In fact, the World Health Organization includes ketamine on its “List of Essential Medicines” for its use in anesthesia.
Ketamine does not depress the cardiovascular or respiratory systems like other anesthetics and because of this, ketamine has been used extensively in anesthesia and on the battlefield by the armed forces.
In the 1980s and 90s ketamine was abused as a party drug-using high doses in a short period of time. This abuse damaged the reputation of this important drug and temporarily impeded research for legitimate medical purposes.
Fortunately, the last 15-20 years of research have produced exciting evidence demonstrating the success of low-dose ketamine infusions for the treatment of depression, PTSD, and chronic pain.
Although ketamine is FDA approved for its use as an anesthetic, it is still considered “off-label” for the treatment of mental health and chronic pain conditions.
What Does This Mean?
When a new drug comes to market, it must be heavily researched in order to gain FDA approval for use in a particular condition. When that drug is used for FDA approved condition, it is called “on-label” use of the drug. When a drug is used for a different condition (research not submitted to the FDA on the original application) its use is considered “off-label”. More than one in five outpatient prescriptions written in the U.S. are for off-label therapies. It simply means that the data for the “different” purpose has not been submitted and approved by the FDA. Some examples of off-label use of a medication include can be found here: Stanford Medicine and WebMD.
How Does Ketamine Help Treat Mood & Anxiety Disorders?
Ketamine antagonizes the N-methyl D-aspartate (NMDA) receptor which in turn alters production of the neurotransmitter glutamate. Glutamate is believed to be a major player in the effect of ketamine on depression. Glutamate enhances the production of Brain Derived Neurotrophic Factor (BDNF) and rapamycin (m-Tor). These substances then help to stimulate the production of new synapses (the chemical connections between neurons) in the nervous system. Patients with chronic depression have fewer of these connections.
Like many medications, the full mechanism of action of Ketamine in the treatment of depression is not fully understood. Simply put, Ketamine helps to decrease the activity of overactive neurons while stimulating the production of healthy neurons.
This explanation is based on current knowledge and is subject to rapid change. Information included in this website should not replace a formal consult with your mental health provider.