Electroconvulsive Therapy, or ECT as it is commonly known, was historically considered the “Gold Standard” of treatment for adults with treatment resistant depression (TRD). ECT involves inducing controlled seizures through electrical currents. Although its precise mechanism remains unclear, it likely affects neurotransmitters and neuroplasticity in the brain. ECT does boast high remission rate (63%) and response rates (71%) 1, however, it remains underused in the US and requires anesthesia, which carries its own inherent risks.
UpToDate, an online healthcare resource which describes itself as “the most trusted evidence-based clinical decision support resource at the point of care,” recently updated its topic of “Unipolar depression in adults: choosing treatment for resistant depression.” It now recommends: “Initial approach — For patients with treatment-resistant, severe, nonpsychotic, noncatatonic unipolar major depression, we suggest initially using ketamine rather than electroconvulsive therapy (ECT), based upon efficacy, safety, adverse effects, and patient preferences [42,52,110-113].” [See the full article here: https://www.uptodate.com/contents/unipolar-depression-in-adults-choosing-treatment-for-resistant-depression?fbclid=IwAR1lT_UQnGK84TQ5_suZ9Fd2UN1d9NyiNbYFsIbVI-6MqfUtMy-Y2QGXHZ8#H29355745]
Ketamine, a dissociative anesthetic, has gained attention as a novel antidepressant. It acts on the glutamate system, specifically the N-methyl-D-aspartate (NMDA) receptors. Unlike traditional antidepressants that take weeks to show effects, ketamine works rapidly, often within hours or days. Ketamine Infusion Therapy (KIT) is administered intravenously in a controlled clinical setting. The dosage is typically subanesthetic, minimizing the risks. Recent studies have shown that IV ketamine is noninferior to ECT in treating TRD 1. A concept that is being rapidly adopted as evidenced by the new UpToDate recommendations. IV Ketamine achieves similar symptom reduction as ECT within a shorter timeframe 2. While we love IV Ketamine at K Space Wellness in Central, NJ, there are some things to consider. Ketamine is a treatment for depression, it is by no way a cure. Ketamine’s effects may be transient, necessitating maintenance infusions. Although ketamine is generally well-tolerated, there are transient perceptual disturbances that can occur. Lastly, while ECT is covered by insurance, ketamine infusions are not, but groups are actively working to change that and maybe with this update we are one step closer to making that happen.
If you or your loved one is struggling with depression, contact us today! kspacewellness@gmail.com
