How does ketamine work to reduce my depression

Hello,

This is Dr Justin Yanuck MD and I’ve given myself 10 minutes to answer this patient question. This weeks question centers on how ketamine works

Answer:

This is something that is easily searchable, but I will try and distill it down in a more digestible way, and focus less on the jargon of this space, and more on what most people care to know.

Ketamine is a medication that has multiple uses. It is a dose dependent medicine and the way we use it in our clinic is either via the intravenous route or the nasal spray route (Spravato). The brain is full of electrical circuits called neurons. One of the primary ways ketamine works is by blocking a receptor on these electrical circuits called the NMDA receptor. For anesthesia, at high doses, this blockade of this receptor leads to the blockade of communication between certain neurons, especially in the parts of the brain tied to memory, self-awareness, and sensory integration). This allows for procedures to be done without the perception of pain or even the perception of self. Hence why ketamine is called a dissociative anesthetic. It disconnects the brains perception of the body and surroundings.

Now in our clinic…that is not the goal. Like many medicines, the effect of ketamine is much different at lower doses. For reference, an anesthetic dose of ketamine is 1-2mg of ketamine per kg of body weight pushed over 1-2 minutes into an IV. Whereas doses for depression, anxiety start at 0.5mg/kg of ketamine…. over 40 minutes! This lower dose of ketamine allows for a much different experience, and a much different outcome.

OK now to the meat of it. How does it work for mental health issues such as depression and anxiety. Let’s leave the jargon fully behind, sorry about the above part, could not avoid certain words like dissociative. So, in chronic stress states (depression, anxiety, ptsd and more) the neural pathways of the brain prune down to small, fixed channels of communication. We see this on images that track neural connections as well as multiple animal models. Think of it this way. Traumas are evolutionarily designed to be given priority in the mind. The rest is just noise. I need to know that when a hard object is coming towards me, I need to duck, otherwise I get hit. I can’t sit there and spend time processing it, trying to understand what it is, and what it might feel or taste like. Just need to duck!

Our minds do this all the time, and the extreme manifestation of this psychologically is these fixed negative thought spirals such as “I am worthless” or “nothing good will ever happen to me” or full dissociation, where one has zero conscious recollection of traumas that happened to them…but their bodies and unconscious mind do!

Ketamine rapidly expands the pruned-down neural networks. This rapid increase in neural connections allows for the ability to recollect prior memories (many of which have been suppressed) and think about things in a different way. This can manifest as recalling past traumas, or it can manifest as findings a sense of collective love and wonder at the world and the simple things in life. The key is expansion of the mind and what comes next depends largely on the work after the infusion including self-directed and with help (psychotherapy). Ultimately, this expanded consciousness opens one to leaving their current fixed thought spirals and start to more easily explore other ways of thinking about things.

This might either sound overly simplistic, or to others, too good to be true, but this is really the core of how this medicine works. There is some beauty in the simplicity of it. In a very real way, it is healing from within, and this is why I routinely see patients get treatment and not need treatment any further after they are done.

So how does ketamine work? It opens the mind. The rest is up to you.