Depression

Major Depressive Disorder is one of the most common mental health conditions in the US. Symptoms present for the majority of a two-week time interval, are variable, and may include feelings of hopelessness or worthlessness, irritability, loss of an interest in activities of daily living and hobbies, difficulty sleeping, changes in weight and/or appetite, and thoughts of death or suicide.
Mental health statistics 5

Zarate CA, Singh JB, Carlson PJ, et al. A Randomized Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Major Depression. Arch Gen Psychiatry. 2006;63(8):856–864. doi:10.1001/archpsyc.63.8.856

Berman RM, Cappiello A, Anand A, Oren DA, Heninger GR, Charney DS, Krystal JH. Antidepressant effects of ketamine in depressed patients. Biol Psychiatry. 2000 Feb 15;47(4):351-4.

aan het Rot M1, Collins KA, Murrough JW, Perez AM, Reich DL, Charney DS, Mathew SJ. Safety and efficacy of repeated-dose intravenous ketamine for treatment-resistant depression. Biol Psychiatry. 2010 Jan 15;67(2):139-45. doi: 10.1016/j.biopsych.2009.08.038.

Luckenbaugh DA1, Niciu MJ1, Ionescu DF1, Nolan NM1, Richards EM1, Brutsche NE1, Guevara S1, Zarate CA2. Do the dissociative side effects of ketamine mediate its antidepressant effects? J Affect Disord. 2014 Apr;159:56-61. doi: 10.1016/j.jad.2014.02.017. Epub 2014 Feb 18.

Murrough, Perez, et al. “Rapid and Longer-Term Antidepressant Effects of Repeated Ketamine Infusions in Treatment-Resistant Major Depression” Biological Psychiatry 2013 Aug 15; 74(4): 250–256.

Shiroma, Johns et al. “Augmentation of response and remission to serial intravenous subanesthetic ketamine in treatment resistant depression” Journal of Affective Disorders. 2014 Feb;155:123-9.

Bipolar Disorder

Bipolar disorder or manic-depressive illness, involve unusual shifts in mood, energy, activity levels, and the ability to carry out of daily activities. It is the sixth leading cause of disability worldwide. Bipolar I, II, cyclothymia, and specified/unspecific and other related disorder are the four classified types of this condition. Medications such as mood stabilizers, atypical antipsychotics, antidepressants, in addition to psychotherapy and electroconvulsive treatment may provide relief. Mood changes readily occur even with proper treatment and relapse is occurs in 40-60% of patients.

Severe Anxiety

Anxiety disorders, the most prevalent psychiatric condition in American, are a persistent and often increasing state of worry or fear that interfere with activities of daily living, social interaction, and wellbeing. Generalized anxiety, panic disorder, and various phobia-related disorders are types of anxiety disorders.

Commonly, benzodiazepines and buspirone (anti-anxiety medications), antidepressants, and beta-blockers along with psychotherapy are used to treat anxiety disorders. It is estimated that 40% of patients with anxiety disorders are treatment resistant.

Bystritsky A. Treatment-resistant anxiety disorders. Mol Psychiatry. 2006;11:805-814.

Taylor, Jerome H et al. “Ketamine for Social Anxiety Disorder: A Randomized, Placebo-Controlled Crossover Trial” Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology vol. 43,2 (2017): 325-333.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is chronic or short-term development of reactionary symptoms as a result of trauma or situation. While the signs and symptoms are different for every person with PTSD, they involve event re-experiencing, avoiding thoughts or behaviors, trigger arousal and reactivity, and cognitive and mood changes.

Individuals suffering from PTSD are treated with antidepressant medications, psychotherapy, yet many individuals still experience severe symptom, reduced quality of life, and are at high risk for suicide.

After decades of treatment usage consideration, the San Francisco Veterans Affairs Medical Center is in its 2nd year of using ketamine for military veterans who suffer from post-traumatic stress disorder and depression. Ketamine has yielded successful and “impressive outcomes”.

Ptsd stat

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder (OCD) is a common, chronic mental health condition in which a person experiences uncontrollable, reoccurring thoughts and behaviors. Obsessive urges or distressing mental imagery, such as fear of germs or need for symmetry are alleviated with compulsions or repetitive, response behaviors. Excessive handwashing, arranging items in precise way, checking rituals, and counting are common compulsions.

Many individuals with OCD continue to experience symptoms despite a combination of traditional medication therapies that includes serotonin reuptake inhibitors (SRIS) and selective serotonin reuptake inhibitors (SSRIs), and psychotherapy. In addition to residual symptoms, it is common for patients to experience high rates of relapse.

Preliminary data from multiple research trials support the usage of ketamine is select OCD patients. Ketamine is a promising non-invasive, safe, and well-tolerated treatment option for OCD.

Ocd

Chronic Pain

Chronic pain is any pain lasting more than 12 weeks. While acute pain is a like an alarm or a response to being hurt, chronic pain is more like a malfunctioning alarm, going off when it should not. It may arise from an acute incident like an injury, an ongoing illness, or from no clear cause at all. Symptoms linked to chronic pain include fatigue, poor sleep, nausea, mood disorders, decreased appetite, and impaired mental function. People with chronic pain may experience reduced or limited movement, flexibility, strength, and stamina leading to a disruption in their normal day to day activities.

TYPES OF PAIN

Hyperalgesia and allodynia are two types of pain that are atypical, yet incredibly debilitating.

Hyperalgesia is pain amplification—basically turning up the volume of pain. When they detect pain signals, the nerves send more signals than they should, and the brain over-responds to the input.

Allodynia is pain derived from a stimulus that usually shouldn’t cause any pain at all. It may include a light touch, fabric brushing against the skin, or moderate temperature.

CONDITIONS ASSOCIATED WITH CHRONIC PAIN

  • Complex regional pain syndrome (CRPS)
  • Fibromyalgia
  • Migraine
  • Cancer
  • Nerve compression (sciatica, carpal tunnel syndrome)
  • Neuropathy
  • Lyme Disease
  • Trigeminal Neuralgia
  • Any autoimmune or inflammatory condition

Patil S, Anitescu M. “Efficacy of outpatient ketamine infusions in refractory chronic pain syndromes: a 5-year retrospective analysis. Pain Medicine. 2012 Feb;13(2):263-9.

Lauritsen, Clinton et al. “Intravenous ketamine for subacute treatment of refractory chronic migraine: a case series” journal of headache and pain vol. 17,1 (2016): 106.

Pomeroy, J. L., Marmura, M. J., Nahas, S. J. and Viscusi, E. R. (2017), Ketamine Infusions for Treatment Refractory Headache. Headache, 57: 276-282. doi:10.1111/head.13013

Correll, Maleki et al. “Subanesthetic ketamine infusion therapy: a retrospective analysis of a novel therapeutic approach to complex regional pain syndrome.” Pain Medicine. 2004 Sep;5(3):263-75.