Ketamine Risks - Can Treatment Actually Worsen Depression?

How Ketamine Treatment Can Exacerbate Depression for Some Patients

In recent years, ketamine has emerged as a promising treatment for depression and suicidality. However, some patients report that ketamine therapy has made their depression worse. Concerns have been raised on Reddit and other internet forums about the potential for ketamine to exacerbate depression in certain cases. Here we explore reasons ketamine treatment may backfire for some patients and what precautions individuals should take.

What is Ketamine?

Ketamine is a dissociative anesthetic drug developed in the 1960s and used widely in medical settings as an anesthetic. In lower "sub-anesthetic" doses, ketamine produces a distinctive "high" and psychedelic effects. Due to its recreational abuse potential, ketamine is a Controlled Substance. However, at low controlled doses administered clinically, ketamine has rapid antidepressant effects.

Ketamine for Depression

Research over the past decade has demonstrated ketamine's ability to quickly improve depressive symptoms, even in treatment-resistant cases. Its antidepressant effects may persist for 1-2 weeks after a single dose. Ketamine is especially effective at reducing suicidality.

These findings led to the development of ketamine clinics and intravenous or intranasal ketamine treatments for depression. However, most protocols involve limited administrations over brief time frames like six treatments over three weeks. The benefits for mood tend to be temporary.

Long-Term Use Concerns

While ketamine therapy over the short-term appears relatively safe and effective under medical supervision, less is known about long-term risks from repeated, high-dose use. Some psychiatrists have prescribed at-home intranasal ketamine for daily use over extended periods. This is controversial and unstudied.

Frequent ketamine use carries risks of developing tolerance, needing higher doses for effects and experiencing withdrawal if stopped suddenly. There are also risks to the bladder and other organs from extended exposure. These factors may limit ketamine's viability as a long-term antidepressant.

Worsening Depression

A major concern seen in online depression forums and subreddits is users reporting worsening depressive symptoms, emotional numbness, and suicidality after prolonged ketamine use. There are several reasons this paradoxical effect may occur for some:

• Withdrawal symptoms when not taking it may worsen underlying depression.
• Higher doses may be required over time leading to toxicity effects.
• Long-term NMDA receptor inhibition can impair cognition and mood.
• May inhibit antidepressant neurotransmitters like serotonin.
• Numbing effects reduce emotional processing needed for healing.
• Rebound depression can occur when positive effects wear off.

Vulnerable Populations

Those with certain pre-existing mental health conditions may be at increased risk of negative psychological effects from long-term heavy ketamine use:

• Bipolar disorder - may trigger mania
• Dissociative disorders
• Psychosis
• Addiction/substance abuse disorder

Younger populations and those taking high daily doses without medical oversight tend to report the most issues with worsening depression or suicidal thoughts emerging during chronic ketamine use and persisting between doses.

Precautions for Using Ketamine

For those considering ketamine treatment for depression, these precautions are advised:

Work with a Psychiatrist

A psychiatrist experienced with ketamine therapy can best determine safe dosing, frequency, and duration based on your mental health background and symptoms. They can monitor for side effects.

Start Low, Go Slow

The adage "start low, go slow" is wise advice with ketamine. Beginning with lower therapeutic doses (like 50-100mg intranasal) is recommended to assess effects and tolerance.

Avoid Daily Dosing

Using ketamine no more than 1-2 times per week allows the brain to "reset" sensitivity to its effects between doses and may prevent tolerance. Less frequent dosing limits risks.

Track Symptoms

Monitoring mood, depression scores, and side effects in between doses can identify if symptoms are improving or worsening over the treatment course.

Take Medication Breaks

Periodic breaks from ketamine for several weeks can prevent dependence and allow assessment of underlying depression severity in its absence.

Watch for Warning Signs

Worsening depression, lack of positive mood effect, emotional numbness, or emerging suicidal thoughts signal ketamine treatment may need adjustment or discontinuation.

Avoid Alcohol & Other Drugs

Combining ketamine with alcohol or other substances like benzodiazepines increases risks substantially. It can also obscure its effects on depression.

Integrating Ketamine Appropriately

When used judiciously, ketamine may have a role in treating acute depressive episodes or suicidal crises. However, antidepressant medications, psychotherapy, and lifestyle changes are likely needed for sustained mood improvements in the long-term. Working with a mental health professional can help find where ketamine fits into a broader treatment approach tailored to your needs.

The Risks of Self-Medicating

Obtaining ketamine illegally without medical oversight poses substantial risks. Dosing and frequency are difficult to optimize. Prolonged daily use often backfires. And life-threatening accidents can occur combining it with other substances.

Avoid Quick Fix Mentality

Viewing ketamine as a "quick fix" cure-all rather than part of a process can lead to overuse and disappointment. Ketamine helps treat episodes, but real change comes from the hard work of psychotherapy, lifestyle habits, human connection, and finding purpose.

Address Underlying Issues

For long-term depression improvement, underlying traumas, negative thought patterns, unhealthy behaviors, and biological vulnerabilities must ultimately be addressed through comprehensive treatment and self-care practices.

Ketamine Can Help or Harm

In clinical settings under medical supervision, ketamine can rapidly improve severe, treatment-resistant depression and suicidality. But unmonitored heavy use, especially on a daily basis long-term, may lead to tolerance, needing higher doses, and worsening depression or numbness between periods of relief.

By working closely with a psychiatrist and using careful dosing protocols and tracking, ketamine may be integrated as one component of depression treatment for some people. But more research is still needed on risks of extended daily ketamine use. For sustainable mood improvements, addressing core mental health challenges through comprehensive treatment remains key.

Warning Signs Ketamine May Be Worsening Things:

• Increasing doses needed for effect
• Return of depression between doses
• Emotional numbness when not taking it
• Suicidal thoughts emerging
• Using daily or almost daily
• Combining with other substances

Pay close attention to your mental health over the course of ketamine treatment and be honest with your doctor about any concerning effects. Your well-being and safety should be the top priority.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.