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Ketamine: Should It Be First-Line Therapy?

Ketamine infusion therapy is currently used for treatment resistant depression, in patients who have not benefited—or have not benefited, sufficiently—from one or more traditional oral medications. Not infrequently, I consult with patients who are seeking ketamine therapy after trying a dozen medications, or more. Many have experienced serious side effects, including sexual dysfunction, self-destructive thoughts, insomnia and weight gain.

Ketamine infusion therapy has been shown to be effective in 70 percent of those who receive it, even when other treatments have not worked. And ketamine therapy, used judiciously, is not known to have any significant, persistent side effects.

Ketamine has even been shown to be more effective than ECT, in at least one study.

It is worth beginning a discussion, therefore, about whether ketamine infusions might be a wise first-line therapy to treat depression, not a last resort. Ketamine infusions would be expected to work more quickly than oral antidepressants and might rapidly return patients to those routines and activities that sustained their well-being, before falling victim to depression. Ketamine could stave off suicidal thinking, maybe even before it develops. And ketamine would not be chronically administered (as are many oral antidepressants, which are frequently prescribed for years).

Even when an oral antidepressant is prescribed, ketamine could save patients the usual waiting period for the oral agent to become effective (as long as a few months).

The perfect paradigm for using ketamine infusion therapy to treat depression will be the subject of research for decades to come. Many doctors will likely reserve ketamine for treatment-resistant cases, for the foreseeable future. But if someone I loved were stricken with depression of a serious variety, ketamine infusions would be the very first treatment I would recommend, not the last.

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