Depression

Depression is an illness characterized by persistent sadness and a loss of interest in activities that are normally enjoyed, accompanied by an inability to carry out daily activities for at least two weeks. People dealing with depression may experience some, if not several, of the following symptoms: a change in appetite; restlessness; sleeping more or less; anxiety; loss of energy; reduced concentration; indecisiveness; feelings of worthlessness, guilt, or hopelessness; and thoughts of self-harm or suicide. Major depression is one of the most common mental disorders in the United States. Depression that is left untreated or resistant to treatment significantly increases the risk of suicide.

• Depression affects over 17 million americans, 40% of which do not receive relief with traditional medications and therapies. Ketamine can help  treatment resistant depression as well as post part depression and major depressive disorder.
• Stress and depression decrease neurotrophic factors (BDNF) in frontal cortex and hippocampus leading to structural and neuochemical changes, atrophy and loss of neurons.
• Ketamine reverses loss of neuronal connections and reverses brain atrophy seen in depression and increases BDNF
• Through these mechanisms ketamine provides rapid and robust relief of depression symptoms
• A series of 6 infusions produces antidepressant effects that can last several weeks to months.

Watch these easy to understand youtube video to learn more about depression:

https://www.youtube.com/watch?v=z-IR48Mb3W0&vl=en

https://www.youtube.com/watch?v=IHgoDWM9hAc

https://www.youtube.com/watch?v=eSXZwk8axmI

• PTSD is a mental health disorder that some people develop after experiencing or witnessing a life-threatening, shocking, or dangerous event such as combat, a natural disaster, serious accident, or sexual assault. PTSD is characterized by symptoms that persist for months and years after the initial event, and can include feelings of being on edge, anxiety, depression, upsetting memories, and trouble sleeping. The four main types of symptoms associated with PTSD are: reliving the event, avoiding situations that remind you of the event, an increase in negative beliefs and feelings, and hyperarousal.
• PTSD affects 3.5% of the U.S. population, with women being more likely to be affected than men. It is associated with substantial impairments in functioning and decreased quality of life. Standard treatment of PTSD includes antidepressants like SSRIs, atypical antipsychotics, and psychotherapy (Matthew,2016). The downside to current standard treatment is that it takes weeks to months to work, has poor response rates, and negative medication side effects (Matthew, 2016).
•  Studies show the efficacy of Ketamine in reducing symptoms in as little as 24h by the Impact of Event Scale. A series of  6 infusions over a 2-3 week period can produce long lasting effects.

• Ketamine reduced suicidal ideation quickly and effectively in as little as one infusion.
• Six studies and three case reports were reviewed to assess the effects of subanesthetic ketamine administration on suicidal ideation (SI) (Reinstatler, & Youssef, 2015). Each study demonstrated a rapid and clinically significant reduction in SI, with results similar to previously described data on ketamine and TRD. The review included 137 patients with SI who were treated with ketamine. Seven studies used 0.5 mg/kg IV doses over 40 minutes, one study administered 0.2 mg/kg IV bolus, and another study administered a liquid suspension. Earliest significant results were observed after 40 minutes with longest results of up to ten days post infusion. In conclusion, ketamine resulted in rapid reduction in SI with minimal short-term side effects.

• Ischemic limb pain
• Trigeminal neuralgia
• Post herpetic neuralgia
• Reduce phantom limb pain
• Fibromyalgia
• Migraines
• During the infusion potent pain relief can be experienced. Effects of prolonged ketamine infusions show long-term pain relief for months. 
• A series of 6 infusions lasting 2 hours over a 2 week period is a suggested treatment regimen for producing long term effects

•  A chronic pain condition usually affecting one limb usually after injury, also known as RSD (Reflex Sympathetic Dystrophy)
• Categorized by two types: type I- occurs after any form of trauma, particularly a fracture of soft tissue. Type II involves actual nerve damage.
• Works by blocking NMDA receptors. An excitatory receptor that is a culprit in CRPS
• Ketamine has mild activity at Mu, Kappa opioid receptors
• Reduces hyperactivity caused by spinal wind-up (central sensitization)
• Reduces alloydnia, hyperalgesia
• Anti-inflammatory properties by the release of adenosine in the periphery leads to decreased secretion of inflammatory substances
• A series of 6 infusions lasting 2 hours  over 2 weeks is suggested.

• Anxiety is an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure, increased heart rate, trembling, sweating, and dizziness (APA, 2017). People with anxiety disorders usually have recurring intrusive thoughts or concerns, and may avoid certain situations out of worry (APA, 2017). These symptoms can worsen over time and can affect quality of life, interfering with job performance, school work, and relationships. Common examples of anxiety disorders are generalized anxiety disorder (GAD), panic disorder (PD), and social anxiety disorder (SAD)  
• Ketamine has been shown to reduced anxiety symptoms when administered to people with depression (Hyde, 2015).
• OCD is a mental disorder characterized by intrusive thoughts (obsessions) and recurring behaviors (compulsions). Prevalence is approximately 1% of the population with the average age of onset being 19. Symptoms include repeated thoughts, urges, or mental images and may result in repetitive behaviors such as obsessive cleaning and/or handwashing, repeated arranging and checking on things, and compulsive counting. Individuals with OCD typically cannot control their thoughts and behaviors related to their compulsions. These symptoms can greatly interfere with daily activities including work, school, and personal relationships. People with first-degree relatives diagnosed with OCD are at higher risk for developing the disorder themselves. Those also at risk for developing OCD are individuals who have experienced physical or sexual abuse in childhood or other trauma.
• In one case report, an unmedicated OCD patient was treated with 0.5 mg/kg of IV ketamine over a 40-minute period. This resulted in rapid anti-obsessional effects. a series of 6 infusions is suggested for best results.