What separates ketamine from other depression treatments?

As ketamine gains more favorability as an effective depression treatment, many clinicians may be asking, “what advantages does this treatment offer over others?” At Psych Congress 2022 in New Orleans, Lousiana, Samantha Lau, PMHNP-BC, FNP-BC, CEO of ELEVATEHER and ketamine psychedelic therapist, discussed what sets ketamine apart and when exactly clinicians should turn to it in treatment.

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Samantha Lau, PMHNP-BC, FNP-BC, and a ketamine psychedelic therapist, is the CEO of ELEVATEHER, LLC, a personalized mental health care company that provides result-driven psychiatric care and transformational inner makeover for busy young women who are ready to unveil their vulnerable-badass selves to feel better, work better and love better. She has more than 12 years of experience in psychiatry and has served as a planning committee member at Psych Congress since 2017 and a co-chair of Psych Congress Elevate.

She worked as a West Coast manager and a psychiatric nurse practitioner in behavioral health at Landmark Health and received both undergraduate and graduate degrees in nursing at the University of California, Los Angeles, and completed her post-graduate psychiatric nurse practitioner program from Johns Hopkins University. She is double-board-certified in family medicine and psychiatry.

Read the Transcript: 
Ketamine came out as an anesthetic in the late '60s as a cousin of PCP (phencyclidine) and it's been a very successful anesthetic and analgesic agent for many years because of its own excellent clinical safety profile. You see that being used in the emergency room setting on a daily basis in children, or in adults for short procedures, in outpatient pain management clinics, and also now in the context of psychiatric care and in therapy. The rapid antidepressant effect has been so impressive that, actually, in the late '90s, [The National Institute of Health] (NIH) got interested in studying that potential as well.

The drug itself is an NMDA receptor antagonist. It causes a surge of glutamate, it triggers a cascade of downstream neuro signaling, and it causes brain-derived neurotrophic factors (BDNF), to increase in your brain, which can promote structural and functional connectivity. So, we are really modulating people's brain when they're undergoing ketamine therapy—your brain literally changes.

At what state should we turn to ketamine? Right now, the large evidence base is for treatment-resistant depression, but there are emerging data showing how helpful ketamine can help with people who are struggling with anxiety disorder, post-traumatic stress disorder (PTSD), severe postpartum depression, alcoholism—[on which just recently came out], and some data on obsessive-compulsive disorder (OCD).