Charles Maddix, ARNP, MSN, PMHNP-BC
Apr 9, 2023
A 32-year-old woman, I’ll refer to her as Jessica, had been struggling with depression for nearly 6 years before coming to my office for help. Despite trying multiple antidepressant medications and therapy, she still felt the weight of depression on her shoulders every day. Her depression had become treatment-resistant, and she felt like she had run out of options.
Jessica's treatment-resistant depression (TRD) not only affected her own life, but also had a significant impact on her family members. Her husband and children often felt helpless and frustrated as they watched Jessica struggle with her depression day after day.
“I wished my mom’s depression would go away and I’d have my old mom back.”
Jessica's husband tried to be supportive and understanding, but it was difficult for him to see his wife in such a deep and persistent state of sadness. He often felt like he was walking on eggshells around her, not knowing what to say or do to help.
For Jessica's three children, it was especially hard. They did not understand why their mom was not able to participate in family activities or why she often seemed distant and uninterested. Her eldest daughter remembered how her mom was before the depression, last year, her birthday wish was: “I wished my mom’s depression would go away and I’d have my old mom back.”
The family tried their best to support Jessica, but the constant strain of her depression began to take a toll on everyone.
In October of 2022 I recommended ketamine infusions as a possible solution for her depression. At first, Jessica was hesitant. She had heard of ketamine being used as a party drug and was unsure about its safety and effectiveness for depression. After doing some research and talking with her family, she decided to give ketamine a try.
In November Jessica had her first ketamine infusion and was amazed at the results. After just one infusion, she felt a significant reduction in her depressive symptoms. Her mood lifted and she felt more hopeful than she had in years.
She continued to receive ketamine infusions over the next few weeks and her depression continued to improve. Jessica is now able to connect more fully with her family, engages in activities with her children, and her relationship with her husband has deepened. Seeing her returning to her former self her family is overjoyed and feel hopeful about their future together.
The success of ketamine infusions for Jessica's treatment-resistant depression is not uncommon. Studies have shown that ketamine can rapidly reduce symptoms of depression, even in individuals who have not responded to traditional antidepressant medications (Canuso et al., 2018). Ketamine works differently than traditional antidepressants by targeting the glutamate system, which is involved in learning and memory (Kishimoto et al., 2016). By blocking a specific type of glutamate receptor, ketamine triggers a cascade of neurochemical changes that can improve mood and reduce symptoms of depression.
A study published in 2018 in the Journal of Psychiatric Research found that ketamine infusions led to increases in brain-derived neurotrophic factor (BDNF), a protein that is important for neuronal growth and survival (Fajemiroye et al., 2018). This suggests that ketamine may be able to promote neuroplasticity, the brain's ability to reorganize and adapt in response to changes in the environment or experience.
Another study published in 2021 in the Journal of Affective Disorders found that ketamine infusions increased cortical thickness in the brains of patients with TRD. The authors suggest that this increase in cortical thickness may reflect a structural change in the brain that is associated with increased neuroplasticity (Abdallah et al., 2021).
Jessica's story is an example of the hope ketamine infusions can bring to individuals struggling with treatment-resistant depression. While it may not be the right solution for everyone, it is worth exploring for those who have exhausted other options.
In conclusion, ketamine infusions can provide a significant improvement in depressive symptoms, as was the case with Jessica. If you or someone you know are struggling with depression, please call The Practice at 904.877.1100 or talk with your provider about the treatment options available.
References:
Canuso, C. M., Singh, J. B., Fedgchin, M., Alphs, L., Lane, R., Lim, P., Pinter, C., Hough, D., Sanacora, G., & Manji, H. (2018). Efficacy and safety of intranasal esketamine for the rapid reduction of symptoms of depression and suicidality in patients at imminent risk for suicide: Results of a double-blind, randomized, placebo-controlled study. American Journal of Psychiatry, 175(7), 620-630. doi:10.1176/appi.ajp.2018.17060720
Kishimoto, T., Chawla, J. M., Hagi, K., Zarate, C. A., & Kane, J. M. (2016). If we build it, will they come? Lessons learned from the development of glutamate-based antidepressants. Harvard Review of Psychiatry, 24(1), 32-44. doi:10.1097/HRP.0000000000000078
Fajemiroye, J. O., Abere, T. A., Oladipupo, O. O., & Yakubu, M. A. (2018). Ketamine: pharmacology, clinical uses and potential for abuse. Journal of Psychiatric Research, 103, 157-162. https://doi.org/10.1016/j.jpsychires.2018.05.013
Abdallah, C. G., Averill, L. A., Gueorguieva, R., Goktas, S., Purohit, P., Ranganathan, M., Sherif, M. A., & Krystal, J. H. (2021). Increased hippocampal volume and cortical thickness in ketamine-treated individuals with depression. Journal of Affective Disorders, 282, 252-257. https://doi.org/10.1016/j.jad.2021.01.040
