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June, 2016

A New Solution in the Treatment of Intractable Depression Major Depressive Disorder, Bipolar Disorder, Post-Traumatic Stress Disorder

People struggle under the common misperception that depression and the conditions listed above are largely the product of thought processes. We now know that, for many people, there are very important physical and biochemical components to the persistent nature of these challenges. More importantly, modern science is discovering that there is overlap between how our brains process pain and how our brains process stress and depression. Specifically, we are finding that N-methyl-D-asparate receptors in the prefrontal cortex (PFC) known to be involved in pain processing are also involved in generating mental representations in the dorsolateral PFC, and parallel actions in the medial PFC circuits representing pain and anguish.1 Studies now demonstrate that a well-known antagonist to these receptors, ketamine, can alleviate major depressive symptoms in a matter of hours.2-5 Impressively, in each of these studies, fast improvement was achieved for patients for whom multiple treatment plans with traditional approaches had failed.

Indeed, major depressive disorder, bipolar disorder, and post-traumatic stress disorder cause pain. The pain is so intense, in fact, that more than one million people each year choose suicide instead. Traditional antidepressants affect the reception of dopamine, norepinephrine, and serotonin. They are the first-line approaches to affecting the biochemistry of the brain for people battling depression. However, they are known to be insufficiently effective for an important subset of patients. Prescribers typically tell patients it can take four to six weeks for an anti-depressant to work. In reality, given the number of people who don’t find success with the first treatment plan, it takes months, not weeks, when these first-line approaches find good outcomes. For many patients, months of experimentation with traditional protocols do not produce the needed relief. Today, we see that these conditions do not need to be a life sentence or a death sentence. We are finding that intravenous ketamine treatments are highly effective in the vast majority of patients with these conditions, and that intravenous ketamine can achieve major relief within 4 to 72 hours of the first treatment in many cases.2

Because the use of ketamine for depression is new, and because it requires ongoing, in-office treatments, intravenous ketamine is only appropriate as a second-line approach – after two traditional treatment plans have failed to achieve the needed result. It may also be appropriate for urgent care of patients with strong suicidal ideation. Treatment plans may be customized, but typically involve several infusions over the first few weeks and then every 30 to 60 days for maintenance. This treatment plan is known to achieve strong results in four to 72 hours and, after six treatments, an 85% reduction in the Montgomery-Asberg Depression Rating Scale.2 After six weeks, a minority of patients may no longer require regular treatments. The extent to which more people can successfully taper off IV ketamine is unknown and likely to be an evolving number. Treatment plans such as counseling designed specifically to take advantage of the dramatic relief available through IV ketamine may facilitate the ability to taper off medicines in a way that is not yet measured.

If you or someone you know struggles with major symptoms of depression, bipolar disorder, or post-traumatic stress, please tell them about The Taub Group. Let’s discuss medical options, side effects, costs, and a plan for a brighter future that involves the best medicine has to offer.


  1. Opler L, Opler M, Arnsten A, et al. Ameliorating treatment-refractory depression with intranasal ketamine: potential NMDA receptor actions in the pain circuitry representing mental anguish. CNS Spectrums. 2015; 26: doi: 10.1017/S1092852914000686.
  2. Ann het Rot M, Collins K, Murrough J, et al. Safety and efficacy of repeated-dose intravenous ketamine for treat-ment-resistant depression. Biol Psychiatry. 2010; 67 (2): 139-145.
  3. DiazGranados N, Ibrahim L, Brutsche N, et al. Rapid resolution of suicidal ideation after a single infusion of an N-methyl-D-aspartate antagonist in patients with treatment-resistant major depressive disorder. J Clin Psychiatry. 2010; 71 (12): 1605-1611.
  4. Zarate C, Singh J, Carlson P, et al. A randomized trial of an N-methyl-D-asparate antagonist in treatment-resistant major depression. Arch Gen Psychiatry.
  5. Berman R, Cappiello A, Anand A, et al. Antidepressant effects of ketamine in depressed patients. Biol Psychiatry. 2000; 47 (4): 351-354.

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