According to the CDC, in 2019, a staggering nearly 8% of the United States’ adult population had been taking antidepressants for at least 2 years. A total of almost 25 million people. While this number alone is alarming, this is also a 60% increase from 2010. More than that, almost 16 of those 25 million had reportedly been taking prescription antidepressants for 5 or more years.
So, it’s likely that someone close to you has spent an extended period of time on a prescribed antidepressant medication. Maybe you've even found yourself in this position. But what do you do when you find the pills you’ve relied on so long becoming less and less effective? Some doctors would suggest supplementing your long-time medication. These supplementals or "add-ons" can include lithium, anti-anxiety drugs, anticonvulsants, or antipsychotics.
Now, people diagnosed with treatment-resistant depression can find comfort in a new approach.
What is Esketamine?
After three years of studying the drug esketamine, psychiatry researcher Adam Kaplin is optimistic in its future for treatment-resistant depression. But what is esketamine?
There are two types of ketamine: R-ketamine (arketamine) and S-ketamine (esketamine). Used via IV in hospitals, ketamine clinics, and even veterinary offices is what's known as racemic ketamine, which contains both types. We already use racemic ketamine for anesthetics and pain management. However, esketamine is taken as a nasal spray and used for the exclusive purpose of treating depression.
Why Esketamine is Different
What's the difference between the two types? Esketamine works better with a specific nerve cell receptor than arketamine. Scientists admit there's still a lot they don't know about the difference between the "left-" and "right-handed" arrangements of ketamine. But esketamine in particular has shown promising results in immediately relieving depression symptoms.
If you've never heard the term "treatment-resistant depression" before, you might be a little confused. So what exactly does that mean?
The Ins-and-Outs of Treatment-Resistant Depression
Treatment-resistant depression, also called refractory depression, is defined by depression that does not improve with treatment. This can also include depression that feels improved but not entirely relieved, or depression that comes back over time. If this sounds like you, you're not alone. About one third of adults with depression report their symptoms don't respond to treatment.
Currently, those not eligible for treatment include patients with major medical problems, psychiatric comorbidities, or active substance abuse. Research suggests that a short-term treatment plan is best. This is carried out by a clinical psychiatrist. However, implementation has been somewhat difficult. Patients must be treated at a health care facility and monitored for two hours following administration. Many psychiatrists' offices do not have the space or resources needed for this.
Clinicians are well aware of the bad reputation ketamine has. Also taken recreationally as a club drug nicknamed "Special K," it first hit the scene in the 70s. They're also quick to defend it.
Used properly, ketamine is very safe. It's used regularly in hospitals around the world. According to Medical News Today, "It is considered safe as an anesthetic, because it does not reduce blood pressure or lower the breathing rate. The fact that it does not need an electricity supply, oxygen, or highly trained staff makes it a suitable option in less wealthy countries and in disaster zones."
Future of Ketamine Depression Treatment
One thing almost all psychiatrists can agree on,” says Adam Kaplin, “We need antidepressants that work more quickly and for more people.” There's still a lot we don't know about how ketamine works. However, there’s a clear potential to quickly improve the lives of many people who have been suffering with no end in sight. That’s been enough for researchers and clinicians to do all they can for the past several years to investigate, and now they think it’s enough for the general public to hold onto for hope.