Anxiety, depression, and suicide are on the rise among American youth. But ketamine—a drug historically used as a surgical anesthetic—is showing promise as a treatment that can succeed where other antidepressant medications have failed.
The need for help is dire. A 2019 Pew report said 70 percent of teenagers report anxiety and depression as a “major problem” for them and their peers. Teen suicide rates are climbing, particularly among girls, according to a Johns Hopkins study. And across age groups, roughly one-third of patients struggling with clinical depression don’t respond to traditional antidepressants.
Against that gloomy backdrop, ketamine has emerged as a ray of hope. The FDA recently approved Spravato, a derivative of ketamine administered in a nasal spray, to treat depression. However, clinicians have mainly relied on ketamine administered through IV infusions because they are able to adjust the dosing for individual patients during treatment.
“This is a game-changer,” said Dr. John Krystal, chief psychiatrist at Yale Medicine and a pioneering ketamine researcher, according to a Yale article. “With most medications, like valium, the anti-anxiety effect you get only lasts when it is in your system. When the valium goes away, you can get rebound anxiety. When you take ketamine, it triggers reactions in your cortex that enable brain connections to regrow.”
Depression and Ketamine
Clinical depression has long been recognized as a vast problem, afflicting nearly 7 percent of American adults and emerging as the leading cause of disability in the world, according to TIME. Depression costs the U.S. economy $210 billion annually in lost productivity—including missed days of work and care for related maladies such as anxiety, post-traumatic stress disorder, migraines, and sleep disorders.
Depression has long been considered a “black box” disease, with little known about its cause, and no obvious cures. From the late 1930s into the ‘50s, doctors thought electroconvulsive therapy—shock treatment—was the most effective way to treat depression. Then researchers began developing medications designed to boost levels of the brain’s natural mood-elevating chemicals, eventually giving rise to popular drugs including Prozac, Zoloft, and Lexapro.
While such medications treat depression in about 70 percent of those suffering from it, the remaining 30 percent find little or no relief. But researchers are finding that the ketamine provides speedy and dramatic improvement, particularly among patients who have had no luck with other treatments.
“In the past 20 years, I’ve not seen anything like this,” said Dr. Cristina Cusin, head of the ketamine clinic at Massachusetts General Hospital, according to TIME.
I share Dr. Cusin’s enthusiasm. In my 32 years as a physician treating patients for chronic pain and depression, I have never seen a medication that works as well as ketamine for patients who are trying to break through the dark cloud of depression.
Help for Teenagers
It’s not just adults who suffer. There is growing awareness that depression afflicts children and teenagers as well, sometimes in a life-threatening way.
The Pew study results announced this year found that anxiety and depression led the list of major problems for American teens aged 13-17, with 70 percent flagging it. That was a far higher percentage than those listing bullying (55 percent), drinking alcohol (45), teen pregnancy (34), and gangs (33).
Depression’s worst result—suicide—is the second-leading cause of death (after unintentional injury) among Americans aged 10-14, 14-24, and 25-34, according to the National Institute of Mental Health. Sometimes those deaths come shortly after a patient leaves the hospital in hopes of resuming a normal life.
Ketamine has brought a new optimism. Heartened by success in using the drug to help adults grapple with treatment-resistant depression, researchers began exploring whether it can help young people as well. The early results are encouraging; According to Scientific American, in one Yale trial, “Adolescents who were previously ready to end their own lives” prior to being treated with ketamine “became bright and hopeful” after using it.
Traditional antidepressants take weeks to work and then sometimes yield only modest improvement. By contrast, the Yale study showed dramatic improvement in young patients less than 24 hours after they received ketamine infusions via IV.
The Yale researchers have found that ketamine prompts the brain to build new neural pathways, which gives patients an enhanced ability to move their thoughts and action in a positive direction. It also develops the kind of neural resiliency that can keep depression at bay.
As doctors and other health care professionals administer ketamine, teenagers and their families are reporting results that have been, literally, life-saving.
An Iowa mother, Beth Burgmeyer, wrote in a Des Moines Register column that her teenage daughter had for years suffered from a depression so severe that “she would beg us to let her die.” Her family and doctors tried everything, including repeated hospitalizations.
It was after one of those hospital stays that she attempted to kill herself by jumping from a height of 20 feet. With her spine shattered, the girl had to undergo long months of rehabilitation. She returned to school in a wheelchair, still struggling with depression and suicidal thoughts.
But then she began receiving ketamine treatments. For the first time, she is showing signs of improved mental health. “I’m convinced,” said the mother, “that it’s saving her life.”
Like any powerful drug, ketamine must be administered carefully and monitored closely. I’m convinced that ketamine—when administered in a professional clinical setting—can bring hope to patients who haven’t found it anyplace else.