Ketamine could be 'game changer' for depression

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Burke Carroll has lived with chronic, intense pain for 17 years since the 49-year old Alabama father of two's leg was crushed by a pickup truck.

"I was in absolute severe pain, all the time, 24 hours a day," Carroll says.

Medications didn't relieve the pain or Carroll's deepening depression.

So, Carroll's psychiatrist Dr. Michael Banov suggested he try IV infusions of the drug ketamine.

"I was absolutely terrified because I was worried about the after effects," Carroll says.

With little to lose, Carroll tried it anyway, and within 3 treatments over the course of a week, something in him shifted. He began thinking more clearly.

"It's remarkable, to be honest," Carroll says.

Ketamine has been used in surgery and pain management for 55 years.

Now, it's being increasingly used "off-label," or experimentally, to help depression sufferers like Carroll.

"It's already a game changer," says Dr. Banov.

He is part of COPE Psychiatry, which operates ketamine infusion centers in 6 states, including Georgia. Banov says ketamine is a promising depression treatment for several reasons. For one, it works much more quickly than traditional antidepressants, which can take 4 to 6 weeks to begin working.

"We will know within 2 weeks, if it's effective," Banov says of ketamine.  "So, we do 3 treatments a week, for 2 weeks and, by that period of time, you're going to know."

It's not clear how ketamine treats depression. It's thought to block a receptor in the brain tied to depression, and Banov says it can trigger chemical changes that could allow new neural connections to form. But there is little long-term research, and there are concerns it could be addictive.

"It is a risk. So far, we haven't had patients ask for more, want more, or seem to like it as a euphoric thing," Dr. Banov says.  "They like it as a therapeutic thing."

The doctor says they use low, carefully controlled doses of ketamine to treat depression.

During Burke Carroll's infusion, his vital signs are monitored by a clinical research nurse. 

Carroll has experienced one odd, but common, side effect. He had an out-of-body experience, where he briefly felt like he was floating outside himself.

"Typically the response we get from patients is, 'That was weird, or that was different,'" Banov says.

In higher doses, ketamine can cause hallucinations, which is why it has been abused as a party drug.

"But, in psychiatry, one of the biggest risk is in people who have psychotic thoughts," Dr. Banov cautions.  "It can actually make that worse."

Banov says ketamine has a very narrow therapeutic window.

"What that means is, too little probably won't do too much, and too much can actually make you worse," he says. "So, that is the beauty of doing it intravenously, is, we can control exactly how much you're getting."

An online search of ketamine clinics in Georgia found 6 clinics, run by doctors in various medical specialties. Banov says before you try ketamine for depression, consult a psychiatrist to get a clear diagnosis and rule out the possibility of psychosis.

"There are a lot of ketamine clinics out there," Banov says.  "Many of them are run by family physicians and anesthesiologists, who are probably very skilled at administering ketamine, but may not be as familiar with the nuances of treating depression."

The Food and Drug Administration has "fast-tracked" the development of some new ketamine-like medications, but the drug is not approved to treat depression.

"So we are still flying a little bit by the seat of our pants, and patients know that," Banov says.  "So, they sign a consent form that tells them this is an off-label use. Insurance won't pay for it because it's not approved for depression."

Burke Carroll has had 8 infusions, at about $400 each. His insurance company will cover treatments for pain, but not for depression. For the first time in nearly two decades, Carroll says, he feels hopeful about his future and watching his children grow up.

"I'm in a much better place," Carroll says.