Ketamine for depression (Washington Post article)

Ketamine has received a lot of publicity lately as a novel treatment for depression, and particularly because it seems to work when other treatment options have failed.   As a psychiatrist, it is particularly exciting for me to see a treatment that provides such a large magnitude of change (large effect size), works rapidly (on the order of hours typically), and is generally well tolerated by most folks who receive it.  What the article does not delve into are some of the treatment alternatives.  Ketamine treatments are largely modelled after electroconvulsive therapy (ECT) treatments, where several treatments are given in a burst to get people out of their depression, then followed up by periodic booster treatments.  While ECT has been around for many decades, use of ketamine for psychiatric indications (treatment of psychiatric diagnoses) is relatively new, being about a decade old.  Luckily, we have plenty of safety data from use of much higher doses of ketamine in anaesthesia, and it has proved remarkably safe.  When considering options for treatment resistant depression, many individuals are rightfully worried about the cognitive side effects of ECT such as memory loss and amnesia.  Ketamine, at least in the doses used in clinical treatment, does not seem to have such adverse effects.  While the benefits do appear to exceed the risks currently, it is important to monitor side effects and the growing scientific literature, as there is much remaining to learn about the long term used of ketamine for treatment of depression.  Still, at this point ketamine is an exciting new treatment option for patient and doctors alike.  Readers who are potentially interested in receiving such treatments are invited to browse my page on ketamine here.