As we focus on mental health this October, it is important to remember that depression is among the many crises facing South Africa. A 2022 study by Wits highlighted key findings: South Africans suffer from depression and anxiety at higher rates than other countries. Only a quarter of these are ever treated. And because treatment requires costly, long-term psychologist visits or psychiatric prescriptions, some people resort to unconventional treatments. Among them, there is a significant increase in people treating their symptoms with psychedelics. There is now an increase in the use of ketamine to treat depression in cases where other medications have failed. Amazing, right? Not so much, experts say.
According to experts, using ketamine for depression is a revelation (more on that below). What is problematic, however, is its abuse as a party drug and its increasing unsupervised use to treat depression.
“The anesthetic can bring life-saving hope to people suffering from treatment-resistant major depression or who are at high risk of suicide. But unsupervised use or excessive dosages pose addictive and even fatal risks,” the South African Society of Psychiatrists (SASOP) warned in a recent press release.
So… what is ketamine?
Ketamine is an anesthetic originally used in animals since the 1960s. It has been used in humans to treat pain since the 1970s. It is listed on the World Health Organization’s List of Essential Medicines as an anesthetic. It is also approved in South Africa for the induction and maintenance of anesthesia. If you break a bone, a doctor might use ketamine instead of general anesthesia.
When used recreationally, K triggers dissociative sensations and hallucinations. Users report feeling relaxed, dreamy, and nauseous. In its most recent era, K is a breakthrough treatment for depression, and others claim it works for other mental illnesses as well.
How does ketamine help with depression?
Ketamine is available for off-label use. This means that regulations allow doctors to use it for purposes other than pain management. Studies have shown it to be an effective treatment for depression and suicidal thoughts, especially in cases where other medications have not worked.
“There is good evidence that ketamine in low doses, administered under controlled conditions and with necessary medical supervision, is an effective treatment for treatment-resistant major depression,” explains SASOP spokesman and psychiatrist Dr. Bavi Vythilingum. “It is also effective for acute suicidal thoughts and quickly reduces the risk of life-threatening thoughts and actions.”
How does it work?
Image by Maxim Berg on Unsplash
According to Dr. Vythilingum improves K the production and function of the neurotransmitter glutamate. This plays a role in mood, thought patterns and perception.
Ketamine has a different mechanism of action than traditional antidepressants. And that’s why medical researchers believe this is at least one reason for its effectiveness where other treatments have failed. In contrast to conventional antidepressants such as SSRIs, which take weeks to take effect, ketamine takes effect quickly. It also doesn’t act on the same brain receptors.
READ MORE: Why toxic positivity is harmful and what to say instead
How is ketamine administered for depression?
To use ketamine for depression, you must go to a treatment facility. There you will be given a dose intravenously. This takes approximately 40 to 50 minutes and there is additional time to recover afterwards. After treatment, you will need someone to drive you home – you will not be allowed to drive until the person has had a full night’s sleep.
But after just one session you don’t feel well. The initial treatment takes place in six sessions over two to three weeks. The treating psychiatrist can prescribe maintenance therapy in individual cases.
The dissociative state (the trip) caused by ketamine can produce feelings of a trance-like state or hallucinogenic experience, feelings of an “out-of-body experience,” feelings of unreality, visual and sensory distortions, and euphoria or “a buzz.”
“For this reason, it is important that the environment is safe, that is, that it is quiet and private, that the treatment is medically monitored, that the patient is not left alone during treatment and recovery, and that the facility is equipped to cope is prepared for any possible side effects.” Side effects,” says Dr. Vythilingum.
While the dissociative side effects may also have a positive effect on improving depressive symptoms, she said, other negative side effects could include nausea and vomiting, increased blood pressure, respiratory depression (slowed breathing), sedation and loss of consciousness.
Image by Dima Pechurin on Unsplash
But…ketamine can also be deadly
Although the treatment is a game-changer for many, there are significant risks. “Ketamine is a powerful anesthetic. Too high a dose can cause sedation and unconsciousness, and in very high doses it can lead to dangerously slow breathing and the risk of death,” explains D. Vythilingum. “Even at lower doses, confusion and unintentional injury can occur if ketamine administration is not adequately monitored and the person is not in a safe, controlled environment. Ketamine is also addictive and can be abused.”
Added to this is the increasing number of “independent” clinics offering ketamine treatments for depression and other mental illnesses. SASOP is concerned about these facilities: whether they are correctly diagnosing patients and using ketamine as an appropriate treatment. Treatment also needs to be carefully monitored for harmful side effects.
READ MORE: 4 proudly South African mental health support apps
The side effects of ketamine can be dangerous
Long-term use of ketamine in high doses can cause bladder, kidney, liver, and stomach pain or toxicity, as well as dependence requiring ever-increasing, life-threatening doses. While some claim that ketamine is effective in treating other mental health conditions such as post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD), SASOP points out that there is limited scientific evidence for this.
Image by Alexander Gray on Unsplash
This will help you stay safe during treatment
If you choose to take ketamine for depression, it is completely legal. Just make sure you’ve chosen a facility that’s right for you.
Find specialists
“Ketamine for psychiatric treatment must be prescribed by a psychiatrist. Only a psychiatrist can diagnose depression as being resistant to treatment,” explains Dr. Vythilingum. “This diagnosis is made after at least two courses of treatment with conventional antidepressants without any improvement in symptoms.” She also made it clear that only a doctor could administer the medication, “and both physical and psychological safety in administering Ketamine are of utmost importance.”
SASOP recommends following the South African Society of Anaesthesiologists (SASP) guidelines. These guidelines state that the physician administering ketamine must be an anesthesiologist or certified sedator qualified in advanced cardiac life support and resuscitation.
Check the setup
“Ketamine must be administered in a facility equipped for physiological monitoring (blood pressure, pulse rate, oxygen saturation) and with medications, equipment and qualified personnel to prevent adverse physical or neurological events, including hypertension, cardiorespiratory events, airway management and resuscitation. to cope.” .
“The treating physician or team member should also have expertise in mental health and in dealing with patients who may be restless, anxious or otherwise distressed. In case of a psychiatric emergency, a psychiatrist should be available,” said Dr. Vythilingum.
READ MORE: These 3 mental exercises can help you find your meaning in life at any age
It’s not for everyone
Ketamine is not considered safe for patients diagnosed with schizophrenia or for those with a history of substance abuse. Dr. Vythilingum also warned that while there is strong evidence supporting off-label use of ketamine for treatment-resistant major depression, further research is needed into the long-term effects, side effects and safety of the drug as a psychiatric treatment.
Equip your mind with these readings
