Ketamine, a medication originally developed as an anesthetic drug, is now being used to address treatment-resistant depression.
How does ketamine work to improve depression?
Ketamine works by quickly increasing the activity of the neurotransmitter glutamate in the frontal cortex of the brain while also allowing new synapses to form in the same area. The speediness of ketamine in producing an antidepressant effect occurs because this drug bypasses the traditional serotonin route and goes directly to activating glutamate. This is very different from conventional antidepressants, which first increase the activity of serotonin in multiple different areas of the brain and then ultimately affect glutamate. This process usually takes two to four weeks to take effect, while ketamine yields an almost immediate effect.
Who is eligible for ketamine treatment?
Individuals aged 18 and older with a diagnosis of moderate to severe depression who have not benefited from other forms of treatment are eligible for ketamine treatment.
Individuals not eligible for ketamine treatment include those with active substance use disorders or psychotic symptoms.
Do I need a referral for ketamine treatment?
You will require a referral from your physician or your mental health therapist.
What can I expect in the intake assessment?
Once we receive a referral, you will be seen by one of the Manor Clinic psychiatrists to complete an initial 30-60 minute intake assessment to determine eligibility for the ketamine program. Once eligibility has been determined, you will be provided with information about your treatment schedule.
Which route is ketamine administered at the Manor Clinic?
Racemic Ketamine is administered through a sublingual route. Ketamine sublingual tablets are prepared by specific compounding pharmacies only.
There is another type of ketamine preparation available called Esketamine or Spravato. It has Health Canada approval for use in treatment-resistant depression and is administered as a nasal spray. We can administer intranasal Sparavato too. We do not administer IV ketamine.
What can I expect during my first treatment sessions?
You will meet with one of the Manor Clinic psychiatrists before receiving your first treatment. Manor clinic staff will be administering the ketamine treatment. You will be monitored for 120 minutes after receiving the treatment. The entire session will take an average of 135 minutes.
How quickly does ketamine treatment begin to work?
The antidepressant effects of ketamine have been demonstrated to occur within 24 hours of a single administration. Some patients may see relief within a few days, and some may need repeated treatments.
How long do the effects of ketamine last?
The antidepressant effects of ketamine appear to wear off within 3-12 days after treatment, although some patients remain well for a couple of months. The effects can be maintained with repeated doses of ketamine or other treatment modalities, including pharmacology, psychotherapy, or neurostimulation. However, there is not enough evidence to suggest the best route of administration, treatment interval, or dose of ketamine for maintenance treatment.
What can I expect after completing the ketamine treatment program?
After completing treatment within our program, you will be referred to the referring physician for further treatment recommendations and ongoing care. Our psychiatrist cannot offer you ongoing follow-up after your ketamine treatment is complete.