Ketamine Treatment for Mood Disorders

Mood disorders occupy a vast spectrum of mental health issues where a person’s emotions impact their ability to function. Their emotions are often, but not always, inconsistent with their circumstance or living situations.

Mood disorders can affect all aspects of a person’s life, such as their sleep or eating habits, further increasing the mood disorder’s symptoms. These disorders may occur at any age.

The symptoms and underlying cause can vary widely but some common symptoms are:

• Persistent and debilitating sadness
• High Anxiety
• Sudden irregular changes in moods with no clear cause
• Anger outbursts that are hard to manage
• Suicidal thoughts

The spectrum of mood disorders includes:

• Major Depressive Disorder: Long-term depression or extreme sadness that impacts a person’s ability to function. This sadness may be accompanied by apathy (significant loss of interest), low energy, and/or difficulty forming clear thoughts.
• Bipolar: A disorder that causes sudden mood swings, often from a high energy or emotional state to a low one. The high energy or emotional state is called “mania” or “manic state”, while the low energy or emotional one is called “hypomania”, “hypomanic state”, or depressive episodes (Mood Disorders: What They Are, Symptoms & Treatment, 2022).
• Seasonal Affective Disorder (SAD): This disorder is also known as seasonal depression and is caused by changes in sunlight during winter months. SAD commonly starts at the end of autumn and lasts until mid-spring.
• Anxiety disorders: An uncontrollable sense of fear or dread that is persistent or frequently recurring.

Mood disorders can be treated through psychotherapy, medication, or a mixture of both. A discussion with your doctor will help you determine if you or a family member may have a mood disorder, and refer you to a therapist, psychologist, or psychiatrist to provide further testing and treatment.

In some cases, the traditional treatment of mood disorders does not provide consistent or enough relief to the patient. These cases are often referred to as drug or treatment-resistant mood disorders and require alternative forms of treatment. Recent research into possible alternatives for drug/treatment-resistant mood has shown that ketamine provides marked improvements in a patient’s symptoms after a single dose. While further research is needed to examine the long-term effects of ketamine, here is what is known about this treatment option.

Ketamine for treatment-resistant mood disorders can be found in two different types. The most common type is a liquid infusion, either through intravenous access or as a muscular injection, under the direct supervision of a medical team. The second one is as a nasal spray, approved by the Canadian Food and Drug Administration in June 2020. The majority of research on the effects of ketamine on drug/treatment-resistant uses intravenous or injectable ketamine.

In 2021, Walsh et al. published a systematic review of the last 20 years of research on ketamine as a treatment for treatment-resistant mood disorders. Their study found that all the research reported that a ketamine infusion or injection significantly improved depressive symptoms and suicidal thoughts within the first 24 hours, with the effects lasting up to two weeks.

The best results were obtained when the ketamine treatment was paired with other psychotherapy treatments, such as Cognitive Behavioral Therapy, and repeated treatments over two weeks with a maximum of six doses administered.

This improvement in symptoms was not as pronounced for people with Bipolar disorders, where it took longer for effects to be seen, but present by the end of the first day, and this relief did not last as long.

Many mood disorders include anxiety as a symptom; as such, researchers have been able to examine the effect of ketamine on anxiety throughout their research, even when anxiety disorders were not the main focus.

In 2020, a review of published medical research articles by Banov et al. focused specifically on the anxiolytic effect of ketamine. They found that patients being treated solely for anxiety disorders saw improvements in their anxiety within an hour of their ketamine infusion treatment.

This relief from their anxiety continued for up to 10 days, and a weekly ketamine treatment maintained that improvement until the end of the study. Some side effects, mainly nausea, vomiting, and temporary confusion, were observed in all the studies. However, the treatment was considered to be well-tolerated.

The results of ketamine treatments for people with other mood disorders, such as obsessive-compulsive disorder (OCD) or post-traumatic stress disorder (PTSD), are not as well established as those for depressive or bipolar disorders.

The current research on the use of ketamine for the treatment of PTSD demonstrates that it significantly decreases the symptoms of the disorder for up to 21 days after the last treatment, and up to 40 days of improved symptoms (Albott et al., 2018).

As for the treatment of OCD, ketamine has shown promise in providing temporary relief from OCD symptoms, less than a week after a single treatment (Bandeira et al., 2022). However, it may prove to be a valuable tool when combined with psychotherapy and other medications.

Further research is needed to determine how the use of ketamine treatments can provide relief to people with OCD or PTSD.

A review of research on the effects of ketamine treatments for children and youth suffering from mood disorders showed similar results to that of adults (Kim et al., 2021).

However, a higher percentage of children and youths did not respond to the treatments when compared to adult-oriented clinical trials.

The specific reason for the anti-depressant and anti-suicidal effects of ketamine treatments is still being researched. The current belief is that it works by increasing the levels of glutamate, a neurotransmitter that allows signals to move through the brain (Costi et al., 2015).

This increase allows the brain to create new neurons and pathways, a process known as neuroplasticity. By increasing the brain’s neuroplasticity, the ketamine treatment allows the patient to change established brain patterns linked to depression, OCD, Bipolar, anxiety, and PTSD cycles.

As the use of ketamine infusions and injections is a relatively new treatment option, it should not be considered the first option to address mood disorders. The use of ketamine for mood disorders is suggested for people whose mood disorders cannot be managed by other medical and therapeutic means.

Some patients with mood disorders may have additional health conditions that prevent them from receiving ketamine.

If you have one of the following conditions, ketamine may not be suitable for you:

• Addiction to another substance
• Hypertension/High blood pressure
• Heart diseases
• Liver issues
• Past history of intracranial pressure increase
• Past history of an adverse/allergic reaction to ketamine
• Pregnancy or currently breastfeeding
• Schizophrenia

It is important to discuss if ketamine treatment is appropriate for you with your medical team before making any decision.

While ketamine has been used since the 1970s and is considered safe when administered by medical professionals, it does have side effects (Rosenbaum, 2022).

Some common side effects are:

• Confusion
• Dissociation
• Dizziness
• Double-vision
• Nausea and vomiting

These side effects should not last very long and can be addressed by the medical professionals overseeing the treatment.

Some serious side effects, which may contraindicate the ketamine treatment, are:

• Apnea requiring respiratory support
• Cardiac arrhythmias
• Hallucinations on waking
• Heart attack
• Severe allergic reaction
• Seizures
• Stroke

The Wilderman Medical Clinic currently offers ketamine infusion treatments for the following mood disorders:

• Depressive disorders
• Anxiety disorders
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorders

In order to receive a ketamine infusion treatment at the clinic, your psychiatrist (or our staff psychiatrist) needs to provide a referral for that specific type of treatment. It should not be considered the first treatment option for your mood disorder.

If you and your medical team believe that ketamine infusion may help with your treatment-resistant mood disorder, please visit the Ketamine Infusion Treatment page or contact the clinic directly.

As ketamine infusions for mood disorders are still being researched, the treatment is not covered by OHIP.

Albott, C. S., Lim, K. O., Forbes, M. K., Erbes, C. R., Tye, S. J., Grabowski, J. J., Thuras, P., Batres-Y-Carr, T., Wels, J., & Shiroma, P. R. (2018). Efficacy, Safety, and Durability of Repeated Ketamine Infusions for Comorbid Posttraumatic Stress Disorder and Treatment-Resistant Depression. The Journal of Clinical Psychiatry, 79(3). https://doi.org/10.4088/jcp.17m11634

Bandeira, I. D., Lins-Silva, D. H., Cavenaghi, V. B., Dorea-Bandeira, I., Faria-Guimarães, D., Barouh, J. L., Jesus-Nunes, A. P., Beanes, G., Souza, L. S., Leal, G. C., Sanacora, G., Miguel, E. C., Sampaio, A. S., & Quarantini, L. C. (2022). Ketamine in the Treatment of Obsessive-Compulsive Disorder: A Systematic
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Costi, S., Van Dam, N. T., & Murrough, J. W. (2015). Current Status of Ketamine and Related Therapies for Mood and Anxiety Disorders. Current Behavioral Neuroscience Reports, 2(4), 216–225. https://doi.org/10.1007/s40473-015-0052-3

Kim, S. S., Rush, B. S., & Rice, T. (2021). A systematic review of therapeutic ketamine use in children and adolescents with treatment-resistant mood disorders. European Child & Adolescent Psychiatry, 30(10), 1485–1501. https://doi.org/10.1007/s00787-020-01542-3

Mood Disorders: What They Are, Symptoms & Treatment. (2022). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17843-mood- disorders

Rosenbaum, S. B. (2022, November 24). Ketamine. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK470357/

Sinner, B., Graf, B.M. (2008). Ketamine. In: Schüttler, J., Schwilden, H. (eds) Modern Anesthetics. Handbook of Experimental Pharmacology, vol 182. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-74806-9_15

Walsh, Z., Mollaahmetoglu, O. M., Rootman, J., Golsof, S., Keeler, J., Marsh, B., Nutt, D. J., & Morgan, C. J. A. (2021). Ketamine for the treatment of mental health and substance use disorders: comprehensive systematic review. British Journal of Psychiatry Open, 8(1). https://doi.org/10.1192/bjo.2021.1061