Patients’ stories abound demonstrating the rapid and robust antidepressant and antianxiety effects of ketamine. And there is substantial scientific research to support the efficacy of ketamine in treating depression and other mental health conditions despite the medication not having FDA approval to treat these conditions. The issue now is if you do respond to ketamine, how do you maintain the benefits? This is an issue that has plagued health care providers who treat people with this cutting-edge therapy and to some patients who have greatly improved with a course of ketamine but have found some of their success wane over time. In our clinic, we have found many possible solutions when this arises.
Antidepressants that once worked and now no longer are working is not unique to ketamine. This phenomenon was first called “Prozac poop out” (or the scientific name “antidepressant tachyphylaxis”) after the first new generation antidepressant Prozac. This effective and well tolerated medicine changed the way depression and anxiety was being treated. However, over time some patients found their depression returning and needed either higher doses, different medicine, or an additional medication added. This was observed with other antidepressants as they became available.
Fortunately, with ketamine, like antidepressant medication, not everyone experiences “poop-out” but if you do, here are some things you can do:
- Make sure the ketamine really isn’t working as well. Sometimes it can be hard to distinguish whether the depression really is returning or it’s just a bad day, week, or even month. Maybe stress at home or work, a major life change, seasonal mood swings, or an anniversary of a traumatic event can bring on feelings that mimic depression coming back. Ketamine, like antidepressants, can treat depression but it’s not magic happy juice that makes everything better all the time.
- We educate all our patients getting ketamine that making positive life changes is essential for ketamine to work and keep working. That means eating well, getting enough sleep, staying physically and mentally active, avoiding drugs and alcohol, and reducing stress as much as possible.
- You may need a dose increase. We find many patients develop tolerance over time and may require higher dose to maintain the benefit. The research is good on what doses are effective to get better but lacking in what doses are needed to stay better. Another good reason to make sure whoever is administering ketamine is highly experienced in this area.
- You may need to add a medication or make a medication change. As much as we would hope the ketamine would eliminate the need for any other antidepressant (and sometimes it does), we find ketamine works best and lasts longer if someone is on an effective and well tolerated antidepressant along with the ketamine. Ketamine appears to help medicines that have not been that helpful in the past work better. We say it works like “brain fertilizer” and medicine, psychotherapy, and life changes are the “seeds.”
- Make sure you not on any medicine that could dampen the benefits of ketamine. Some examples may be naltrexone or high dose anticonvulsants, opiates, and benzodiazepines. Some untreated medical conditions may impact ketamine treatment such as poorly controlled thyroid disease, diabetes, or vitamin deficiencies. Make sure whoever is treating you knows how to treat mental health conditions beyond just giving ketamine.
- Consider starting or changing the type of psychotherapy you are getting. Ketamine creates a powerful dissociative experience that can be used as a tool to make psychotherapy more effective by breaking down psychological blocks, improving insight, and making the brain more flexible to incorporate the changes gained in the therapy process. Having a therapist who is trained to work with someone receiving ketamine treatment may improve not only response but also maintenance of effect.
While ketamine can be a powerful tool in overcoming mental health problems, it is not a fix in and of itself without making the necessary life changes- both physical and psychological. An initial positive response to ketamine treatment may trick you into thinking that it’s a quick and easy answer to depression and anxiety but likely bad lifestyle habits or psychological issues that have not been addressed can eventually impact the effectiveness of treatment. If your ketamine success seems at risk, there are solutions. It may just take some work to turn thing around. But it’s well worth working for.