Tuesday, March 28, 2023

Everywhere you turn you cannot help but see the many ways in which the COVID pandemic has affected us. In few places has the impact been more devastating than in the realm of mental health. All of us are facing challenges that can be stressful and overwhelming, but for those with underlying psychiatric disorders, these pressures have been particularly damaging. According to a recent report in The Lancet, the pandemic has caused an estimated 53 million new cases of major depression worldwide in 2020, a 25% increase.

At the same time, the mental health system is overloaded. But even those patients who are able to access treatment do not always find satisfactory improvement with the prescribed antidepressant or mood stabilizing medications. Patients with depression who don’t improve with the initial treatment of antidepressants often don’t respond to subsequent medication trials, and are forced to live with debilitating and often chronic depression.

While many new classes of antidepressant drugs have been developed since the SSRIs were introduced in the 1980s, they all share the same mechanism of action, which involves increasing or modulating monoamine neurotransmission (ex: serotonin, dopamine, norepinephrine pathways). Patients who do not respond to this approach are left with limited options. Yet amidst this discouraging news, there has been a pharmacologic breakthrough in the field of psychiatry.

Over the last few years, there has been increasing excitement about promising research that repeatedly demonstrates that depression, anxiety, post-traumatic stress disorder (PTSD) and other psychiatric conditions can be positively treated with ketamine, even when traditional medications are ineffective. A well known anesthetic medication for surgery, ketamine has now been shown to have incredible effects when used at lower, subanesthetic doses where the patient remains awake. Just recently, the American Journal of Psychiatry (May, 2021) published an article that summarized this exciting research, noting that “The majority of individuals with major depressive disorder who are treated with monoamine based antidepressants [standard antidepressant drugs] fail to achieve full symptomatic and functional recovery” but that ketamine treatment provides “proven rapid onset efficacy… providing hope to affected persons.”

So what is ketamine? The FDA approved it as an anesthetic medication in 1970. Historically, ketamine was used to treat injured soldiers on battlefields in the Vietnam War. Unlike other anesthetic medications, ketamine doesn’t typically slow breathing or heart rate, so it is extremely safe, even on the battlefield. It is still frequently used in emergency departments and operating rooms for both children and adults as an anesthetic for sedation during various procedures.

Research has now shown that in lower doses, given at a slower rate, it is an effective treatment for PTSD, anxiety and mood disorders. For this purpose, ketamine can be administered by two possible routes: intravenous and intranasal. Unlike traditional antidepressant drugs that can take weeks to show improvement, the improvement after ketamine is often felt the same day of treatment, or within a few days. Moreover, while traditional antidepressant medications frequently have unpleasant ongoing side effects (insomnia, weight gain, GI upset, etc.), ketamine does not have this side effect profile. The antidepressant and anti-anxiety effects of ketamine are variable in degree, but about 70% of people who try medically supervised ketamine for a mental health condition (including those with chronic depression), report markedly positive results.

In response to this much-needed, new and exciting therapeutic option, ketamine offices have been rapidly opening across the country. Nearby, on Kinderkamack Road in Oradell, New Jersey, three emergency medicine physicians who are well-versed in ketamine administration from their practice, have partnered together. They have jointly opened MGM Ketamine Center—a brand new, state-of-the-art infusion center ( www.mgmiv.com ).

The MGM physicians are collaborating with psychiatrists and mental health providers in a simple and streamlined process: When the mental health provider sees a patient who may benefit from and is interested in ketamine, they contact an MGM physician, who will then be in touch with the patient to initiate an individualized ketamine plan. Drs. Haviva Malina, Ariella Glaser and Cheryl Malina all agree: “Over the past year, we have seen a dramatic increase in patients seeking emergency psychiatric care. With the newly recognized role of ketamine as a rapid-onset, effective treatment for mood and other psychiatric disorders, we hope to increase awareness of the ketamine option, access to the therapy, and make the treatment experience as smooth as possible.”

By Jewish Link Staff


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