Overcoming depression is an uphill battle that can leave some unable to even get out of bed in the morning. Similarly debilitating is acute and chronic pain, which can make doing the simplest tasks strenuous and sometimes impossible. While antidepressants and opioids are often used, respectively, to help treat these ailments, for some, they’re not effective, leaving patients no better—and sometimes worse—off. Overprescribed, opioids have led to an addiction epidemic, making many wary of them. An alternative to both antidepressants and opioids is a ketamine infusion.
Long used in medical procedures, ketamine is a sedative-like medication administered through an IV by a trained medical professional. With few lasting side effects, the treatment, which may last up to six sessions, can provide longer-term relief for those suffering from acute and chronic pain and even depression. Ketamine can even benefit those with complex regional pain syndrome (CRPS or RSD). Here, Dr. Uplekh Purewal offers insight into the treatment and who can benefit.
Q: What is a ketamine infusion?
A: It’s a slow intravenous infusion of a widely used pain and sedative-type medication. It can help with pain issues like complex regional pain syndrome, depression and anxiety. It should be delivered under the care of a health care professional such as an anesthesiologist or psychiatrist.
Q: How does a ketamine infusion work?
A: The patient presents first for a complete medical evaluation to determine if they have a qualifying condition. An appointment is then made to present to the infusion center, where the IV is started. The infusion takes place over about an hour. During that time the patient rests comfortably in a reclining chair and may drift off to a restful state. Once the infusion is completed and the patient is comfortably awake, they are discharged to home.
Q: How does ketamine work on acute and chronic pain?
A: Ketamine works very well for acute and chronic pain, as well as depression and anxiety. It works differently for pain, by blocking the NMDA receptor, which is different than regular opioids. It has been used widely to treat complex regional pain syndrome as well. Ketamine has a rapid antidepressant effect, unlike traditional antidepressants, and has been used in treatment-resistant depression for years.
Q: How does ketamine work on your mental health?
A: It is related to the antagonism of the NMDA receptor in the brain and the release of neurotransmitter glutamate. This results in a rapid change in the chemical structure of the brain, which may result in a lifting of depressive moods and suicidal thoughts.
Q: Who is a good candidate?
A: Ideal patients include those with chronic pain that are resistant to opioid treatment or conventional medications, including those with chronic pain that is resistant to opioid treatment or conventional medications, as well as those with major depressive disorder or treatment resistant depression. It has also been effective in the treatment of complex regional pain syndrome (RSD-reflex sympathetic dystrophy).
Q: How soon do patients see results?
A: Patients may see results immediately after the infusion. In some studies patients had a sustained improvement of their pain or depression after one low dose infusion. Most centers will have patients returning for a total series of six infusions. Some patients will have sustained effects that may last for six months to a year. Results will vary on each individual patient.
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