Last month, an FDA advisory board recommended that federal regulators approve a new depression treatment—a nasal spray with ketamine as the active ingredient. This treatment has been marked as a “breakthrough therapy,” meaning that the review process is sped up due to the treatment being intended for a life-threatening condition.
What is Ketamine?
Ketamine was first introduced in the 1960s as an anesthetic and is commonly used by veterinarians as a tranquilizer and anesthetic for animals. It is also a popular club drug, known as “Special K.” While the particular compound in the nasal spray, esketamine, is not the same as ketamine, there is still some concern about the abuse of the nasal spray treatment.
Researchers first began researching ketamine as a treatment to depression after discovering anecdotal evidence that the drug’s effects could help users manage the symptoms of depression. Ketamine causes feelings of euphoria and dissociation or out-of-body experiences. For these reasons, it’s become a rather popular club drug, but the clinical implications of ketamine may point to the drug as a relief for patients struggling with difficult-to-treat depression or who cannot handle the side-effects of SSRI medications.
Treating Depression with Ketamine
The nasal spray treatment was developed by Janssen Pharmaceuticals Inc., a subsidiary of Johnson & Johnson, and will be marketed under the name Spravato. The nasal spray isn’t actually ketamine-based, but rather uses a chemically similar compound developed for the drug, called esketamine. Spravato is intended for patients who have tried at least two other forms of depression treatment without success.
Spravato is planned to be administered only by physicians and will not be available for at-home use, even with a prescription. Instead, patients will need to make weekly or bi-weekly appointments to allow their physician to administer the spray and then remain under supervision for up to two hours afterward.
Concerns About Ketamine-Like Depression Treatments
Due to concerns regarding abuse, Spravato will only be administered under the supervision of a doctor to restrict patient access to the drug. Critics of the treatment have voiced concern about the long-term use of the drug since there hasn’t been significant research into the long-term effects of ketamine or esketamine.
Spravato also lists a number of serious side effects, though it’s worth remembering that these side effects have been linked to other antidepressants as well. Some of the known side effects of Spravato include:
- Nausea and vomiting
- Anxiety
- Dizziness and vertigo
- Lethargy
- Increased blood pressure
- Feelings of drunkenness
- Hallucinations
- Sedation
- Decreased sensitivity
- Dissociation
The FDA plans to mark Spravato with a boxed warning to alert patients of the risks of “sedation, and difficulty with attention, judgment and thinking (dissociation), abuse and misuse, and suicidal thoughts and behaviors after administration of the drug.”
Combining Ketamine and Transcranial Magnetic Stimulation
Both Spravato and transcranial magnetic stimulation (TMS) have been hailed for their effectiveness in treating treatment-resistant depression, which led researchers to wonder if these two treatments could be combined for a better treatment outcome.
One study on the combination found that ketamine could be used in conjunction with TMS to treat acute depression symptoms and bring relief more quickly than traditional treatments, such as antidepressants and therapy. This tiered treatment approach can be helpful for patients with treatment-resistant depression to address a mental health crisis and begin a longer-term therapeutic intervention.
Researchers are still studying the long-term effectiveness of ketamine and TMS treatments for depression, but for now, they are optimistic about this combination for rapid, short-term treatments.
Drug-Free Alternative Treatments for Depression
Many treatments for depression are focused on finding the right prescription medication to relieve symptoms. Unfortunately, ketamine and other antidepressants can cause serious, and even dangerous, side effects. These side effects can be a serious deterrent for patients seeking treatment, especially when their depression isn’t effectively treated with medications.
While esketamine shows promise as a treatment for acute or treatment-resistant depression, it too has significant side effects. Researchers still are uncertain of the long-term effects of using ketamine-like substances to treat depression, and there are significant concerns about abuse and long-term health effects.
Transcranial magnetic stimulation, however, is a safe, drug-free treatment for depression that has been proven clinically effective. TMS can be used long-term, and the side effects are minimal. At Pulse TMS, we utilize BrainsWay™ TMS technology, which uses magnetic waves to stimulate specific parts of the brain involved in mood regulation.
Our TMS treatment sessions are short and most patients are able to go right back to their daily lives after their session. TMS is a non-disruptive option for treating your depression, and our team offers flexible scheduling and comfortable sessions that work with your life.
Most patients undergoing TMS treatments report significant improvements in their mood and symptoms by 4 weeks, and most treatment courses will only continue for 6 weeks. In cases where a longer treatment course is required, we may recommend TMS treatments for up to 12 weeks. While most patients don’t require ongoing TMS sessions after their initial treatment course is complete, some may find it beneficial to schedule maintenance sessions. Our team can help you find the right treatment plan for your needs.
If you’re struggling with depression, you don’t need to face your condition alone. At PulseTMS, we’re dedicated to helping individuals treat their depression effectively—without the use of drugs. Our caring team is ready to help you discover if transcranial magnetic stimulation is right for you.
Schedule a consultation to learn more about TMS. Contact our team today to get started.