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The Ketamine "Cure"

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“We’ve gotten used to being anxious and depressed. People have forgotten how life can be.” Dr. Andre Atoian

Worldwide, according to a Gallup Poll, people are increasingly stressed, worried, and depressed. Pandemics, political divisions among families, climate change, and financial uncertainty have worn all of us down. Gallup’s Negative Experience Index has continued to tick up year over year, reaching new heights.

In the meantime, not surprisingly, the Positivity Experience Index reports that people are having fewer positive experiences. “After several years of stability, the Positive Experience Index score in 2021 dropped for the first time since 2017,” reports Gallup.

Before the pandemic and political upheaval, some people were already struggling to get by. Johns Hopkins reports that around 26% of American adults struggle with diagnosable mental illness within any given year, including 10% who struggle with a depressive disorder, such as major depression, bipolar disorder, or dysthymia.

Antidepressions have been shown to work best for people who suffer from severe depression. Of course, some are better than others. But the efficacy, according to the National Institute of Health, only shows that they work for about 20% of patients. Dr. Paul Nestadt said, “It’s common for a medication that once worked wonders to become ineffective, especially if you’ve been taking it for a long time. Symptoms return for up to 33% of people using antidepressants.”

A study published in 2022 sought to determine the impact of antidepressants on quality of life by questioning two groups of people with depression: one group that took antidepressants and one that didn’t.

Researchers assessed both mental and physical quality of life with a survey that asked questions about subjects’ physical health, energy levels, mood, pain and ability to perform daily activities, among other things.” But the study showed no difference between the two groups.

If you are part of the one-third of those who suffer with treatment-resistant depression (TRD), your chances of finding a medication that works for any reasonable length of time are slim.

A growing treatment trend for depression, post-traumatic stress disorder (PTSD), and even addiction, is the use of ketamine. Dr. Andre Atoian, et al, published a paper in 2022 on the efficacy of micro-dosing, using a small sample with big results. Twenty-six subjects, ages 29–60, were treated for stress, PTSD, anxiety, and depression. Self-reported scores, using a HIPAA-compliant platform, showed significant results 35 days after completing the treatments.

Subjects experiencing anxiety showed a 100% improvement. 92% showed improvement with stress, 96% showed improvement with PTSD, and 91% showed improvement with depressive symptoms. What’s more, there were no negative side-effects from the treatments.

I had the opportunity to talk with Dr. Atoian about his study and his practice, Limbic Medical, based in Toluca, California.

Unlike most practitioners already working in mental health, Dr. Atoian, an anesthesiologist, came in through the side door. He’d always had an interest in mental health, but was unsatisfied with the traditional method of treatment that provided patients with a concoction of pills that may or may not work. He studied the interaction between depression and pain while working on his undergraduate degree and received a National Science Foundation grant for his approach to identifying novel pain medicines.

His mentor pioneered ketamine and ketamine trips for people in ICU, making the connection between mental health with care for the whole person. Atoian’s practice grew during the opioid crisis when he discovered he could use ketamine as a way to help people break the addiction to opioids and stay off of them.

Atoian identifies a symbiotic relationship between addiction and pain, stating, “People who have problems with substance abuse disorder show higher comorbidity rates of mood disorders and vice versa.”

While depressed patients may not be drug-addicted, recurrent negative thought patterns mimic the effects of addiction. Embedded neural pathways from years of depression make thought changes nearly impossible, even with talk therapy and serotonin inhibitors. Chances of getting better take place when the patient’s perception is changed by being lifted out of the depressed state.

“When we take ketamine, the brain is rewired and that’s the basis of how new habits are formed and old habits are broken,” he says. “A habit is sort of an entrenched way of thinking and an entrenched way of thinking is a neuropathic phenomenon. When we take ketamine, it rewires the brain making new synaptic connections.”

Ketamine treatments are usually offered in three ways: Intravenously, intramuscularly, and through at-home micro-dosing. Intravenous and intramuscular doses of ketamine usually produce psychedelic experiences and provide instant relief from suicidal ideations in most patients. Depending on the severity of symptoms, patients may require one method over the other or a combination of methods to reach the results they need.

Regardless, ketamine by itself isn’t usually an instant cure. A patient needs to be motivated and willing to do the work to address the triggers. At Atoian’s clinic, patients are often referred to outside therapy. “A one-size-fits-all treatment doesn’t work for everyone,” he says. “You have to learn new habits to deal with life stressors. Ketamine helps rewiring and creates emotional space between trigger and response. People recognize their triggers and have space to think about and change their behavior. Exercise, nutrition, and accountability partners are all important components.”

Candidates for ketamine are for “anyone who is stuck” at struggling with depression, anxiety, or PTSD and has tried other treatments, Atoian says. He’s quick to add that ketamine may not be best as a first line of defense. A person should work with their clinician to decide what might be best for them.

But buyer beware. Companies offering at-home ketamine treatments are becoming ubiquitous. Ketamine is cheap to make but profitable to sell. Treatments can cost anywhere from hundreds to thousands of dollars. They aren’t covered by insurance and there is no guarantee of the results. Taking out a loan for treatment, as some are compelled to do, may only add to the stress months later when they are again plagued by depression.

The best approach is to work with your primary care physician, therapist, or psychiatrist to determine if ketamine might be the best treatment option. Some psychiatrists offer ketamine treatments. While the ketamine itself isn’t covered by insurance, a portion or all of the office visits may be. Otherwise, like finding a therapist, find a company that you feel best fits your specific needs within your budget.

When it comes to our mental health, Dr. Atoian makes a good point. “We’ve gotten used to being anxious and depressed. People have forgotten how life can be. The [life satisfaction] goal post has moved so that people aren’t living lives the way they should be.”

Ketamine is not a one-and-done cure. Though ketamine treatments may make a drastic change over a short period of time, like any other medication, further doses are likely to be required. Still, for those whose lives have been debilitated by depression and anxiety, ketamine treatments may be the answer for regaining control and setting the course for getting your life back on track.

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