What is Major Depressive Disorder?
About the Author Dr. Steven P. Levine is a board-certified psychiatrist internationally recognized for his contributions to advancements in mental health care. Though he is a psychiatrist who places great emphasis on the importance of psychotherapy, medication is often a necessary component of treatment, and he was dissatisfied with the relatively ineffective available options with burdensome side effects. Dr. Levine pioneered a protocol for the clinical use of ketamine infusions, has directly supervised many thousands of infusions and has helped establish similar programs across the country and around the world.
It seems every month, an article comes out touting the benefits of Ketamine infusion therapy in treating major depression, bipolar depression, postpartum depression, posttraumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), generalized anxiety, fibromyalgia, or chronic pain conditions. At Actify Neurotherapies, we are lucky enough to have treated thousands of patients with these conditions and the condition we most commonly treat is major depressive disorder (depression). In this blog article, we discuss what major depressive disorder (“depression”) is, how it is treated, and how Ketamine can be used as a novel treatment method.
One in Five Americans Suffer from Depression
An estimated 16 million American adults—almost 7% of the population—had at least 1 major depressive episode last year.1 According to the DSM-5, aka the psychiatrist’s Bible, Major Depressive Disorder (aka depression) occurs when you have at least 5 of the following symptoms for at least 2 weeks:
- Depressed mood or irritable most of the day, nearly every day
- Decreased interest or pleasure in most activities, most of the day
- Significant weight change (gain or loss) or change in appetite
- Change in sleep: insomnia (inability to sleep) or hypersomnia (excessive sleeping) almost every day
- Change in activity: restlessness or psychomotor retardation
- Fatigue or loss of energy
- Feelings of worthlessness or guilt
- Impaired concentration or indecisiveness
- Recurring thoughts of death or suicide
Everyone gets depressed from time to time. In fact, it would be abnormal not to feel sad or depressed for a few days every once in awhile. It is when these feelings of sadness persists for more than 2 weeks and are accompanied by the symptoms above that things become concerning and you should seek professional help to figure out if you have Major Depressive Disorder (depression). If you do have Major Depressive Disorder, then your doctor will likely recommend a few treatment options including medication, talk therapy, or a combination of the two. A more complete list of potential treatment options for depression include:
First Line Therapies
- Antidepressant medications & Psychotherapy
- Antidepressants can be very effective in some patients but they might not have the desired effects. Others will find troublesome side effects and annoying delays before seeing a reduction in depressive symptoms.
- Psychotherapy including cognitive behavioral therapy, psychoanalysis and interpersonal psychotherapy can be very helpful and we recommend continued psychotherapy to our patients who receive Ketamine infusions.
Second Line Therapies
- When therapies listed above fail to adequately improve depressive symptoms, the following treatments can be considered:
- Brain stimulation therapies have been proven quite effective (ECT>TMS), but have significant downsides.
- ECT (Electroconvulsive therapy) is basically shocking your brain and requires you to be under general anesthesia.
- rTMS (Repetitive transcranial magnetic stimulation) requires daily treatments over several weeks and long delays before finding out if it works.
- Ketamine Infusion Therapy
- Ketamine infusion therapy is an appealing new second-line treatment for depression with success rates equal to or greater than ECT and significantly greater than TMS.
- If first-line therapies just aren’t cutting it and brain-stimulation therapies don’t seem appealing, then you may just want to consider Ketamine.
What is Ketamine Infusion Therapy?
Ketamine is one of the most exciting treatments in the world of psychiatry in the last 20 years. It is a truly novel treatment for depression, one of the first since the invention of Prozac in 1972. Just as Prozac changed the world’s thinking on depression and ushered in trends like “Prozac Nation”, we believe that Ketamine will do the same. There are many benefits of Ketamine over traditional antidepressants. One of the best is that most patients will know if their depression will respond to Ketamine after just 1 or 2 infusions. Oral medications take weeks to months before the doctor and the patient can even decide if they are working. Another benefit of Ketamine is its incredible effectiveness. If you take a traditional antidepressant, it will have a less than 50% chance of improving your depression. With Ketamine, the research convincingly shows that up to 70% of patients will have a reduction in their depressive symptoms. This success rate of 70% is even more remarkable considering that many of the studies on Ketamine were conducted on patients who had failed all conventional treatments for depression, including ECT.
The typical course of Ketamine infusion therapy entails 6 treatments (45 minute infusions) over 2-3 weeks, with maintenance infusions thereafter as needed to maintain the effect. Patients are awake during the infusions. Even though it is an anesthesia drug, the patient is not under general anesthesia during the infusion because the dosage is much lower than used for anesthesia. In fact, it is often just a quarter of the anesthetic dose.
Who can benefit from Ketamine Infusion Therapy?
We think that most patients suffering from Major Depressive Disorder (depression) who meet the criteria for treatment resistance are good candidates for Ketamine. Treatment resistance means that a patient has failed 2 or more medication trials. In addition, we feel that patients who are unable to tolerate the side effect profile of commonly prescribed oral antidepressant medications may want to consider Ketamine treatment. Furthermore, at Actify Neurotherapies, we feel that patients should be aware of the option of Ketamine infusions so that they can decide if they would rather try 1 or 2 infusions of Ketamine (with none of the typical antidepressant side effects between treatments) instead of undergoing electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS). We feel that both ECT and TMS are great treatment options for patients who fail Ketamine therapy (and vice-versa) and we often work very closely with our psychiatric colleagues who perform ECT and/or TMS to provide our local communities with the best possible psychiatric care.
To learn more about how Ketamine is being used to successfully treat patients with major depressive disorder (depression), contact us at 888-566-8774 or email us at firstname.lastname@example.org for a free phone consultation to discuss how this treatment can benefit you or your loved one. Actify Neurotherapies is proudly combatting major depression, bipolar depression, postpartum depression, PTSD, OCD, and anxiety one patient at a time!
- NIMH.Prevalence of Major Depressive Episode Among Adults. November 2017.