People living with depression, post-traumatic stress disorder and chronic pain have a new option for treatment in Durango, in the form of an old medication called ketamine.
Dr. Dan Caplin opened the Four Corners Ketamine Center in recent weeks inside his existing clinic, Colorado Addiction Treatment Services, and has already seen it provide relief to patients who have unsuccessfully tried many other options, such as oral medications, he said.
His clinic is one of dozens across the country that have opened in recent years as research supporting the drug has been released, he said.
“We are trying to find some new ways to treat people with intractable conditions,” he said.
However, exactly how the drug works and its long-term effects are still being studied and are not well-understood.
For decades, ketamine has been approved as a safe anesthetic that doesn’t depress the respiratory system as some other drugs will, Caplin said. It works well as anesthetic because it can disconnect the brain from the body and allow doctors to treat extremely painful conditions, such as burns.
Ketamine also has a reputation as an illegal party drug known as “Special K,” which can give the user hallucinations at high doses, he said. It is illegal to possess ketamine for recreational purposes.
Over about the last 15 years, scientific evidence showing ketamine’s effectiveness at treating depression and other conditions piqued Caplin’s interest and led him to open his new clinic.
Rapid resultsKetamine is an attractive treatment because unlike conventional antidepressants such as Prozac, which can take weeks to take effect, ketamine can lift a patient’s mood in hours, said Dr. Boris Heifets, an assistant professor in the Department of Anesthesiology, Perioperative and Pain Medicine at the Stanford University School of Medicine.
But there is uncertainty about how often patients should be infused, and what the long-term effects are, he said.
“Ketamine may be most effective for patients in crisis, where a fast-acting therapy is needed,” he wrote in an email.
After a single treatment, ketamine can end suicidal thoughts, Caplin said.
The drug can also allow patients with depression to experience a remission of their symptoms if the ketamine treatments are stacked, he said. At Caplin’s clinic, patients usually receive six one-hour IV treatments of ketamine over two weeks, he said.
Some patients may experience years of remission from their symptoms through stacked treatments, he said. About half need to take a booster dose every four to six weeks, he said.
For patients who need a booster dose, Caplin plans to give nasal sprays at the center, he said.
For patients with PTSD, ketamine can help provide emotional stability and improved sleep, Caplin said. Research has shown ketamine is more effective for patients with PTSD from short-term events and not as effective for those who experienced ongoing trauma, such as domestic abuse, he said.
For chronic pain patients, such as those with migraines and fibromyalgia, ketamine can also ease or eliminate symptoms, he said.
Ketamine is not recommended for those with a history of substance abuse, a history of psychosis and those with an uncontrolled medical condition, according to Harvard Health Publishing.
Exactly how the drug helps to treat depression and other conditions has yet to be discovered. But researchers have found that it doesn’t interact with neurotransmitters commonly believed to be responsible for depression, Caplin said.
For decades, it was believed depleted levels of neurotransmitters, such as dopamine or serotonin, were responsible for depression. Drugs that interact with those neurotransmitters tend to be effective only a third of the time, he said.
Ketamine triggers the release of glutamate, a neurotransmitter, that stimulates growth of synapses between brain cells, researchers at Yale University found. However, last spring Yale experts were still unsure how long the effects of ketamine could be expected to last.
Treatments elicit emotionsKetamine treatment can bring up all kinds of emotions for patients. Some people laugh or cry and some are completely calm, he said. In some cases, the treatment has allowed patients to process repressed memories and early childhood trauma, Caplin said.
After a treatment, patients aren’t allowed to drive and may feel drowsy, he said.
While patients are receiving the treatments, the clinic’s registered nurse, Peter Meaden, monitors all the patients’ vital signs. As a psychiatric nurse, Meaden also helps them process their emotions if necessary, he said.
The clinic also recommends patients work with a psychologist or other mental health provider, although they do not require it, Meaden said.
Heifets said ketamine seems to have short-term antidepressant effects over a week or two without talk therapy.
Research is still ongoing to determine if talk therapy improves ketamine’s effect or reduces the number of ketamine infusions a patient might need, he said.
“Common sense says that patients engaged in talk therapy with a trusted therapist will have better outcomes,” he said.
While patients can’t develop a physical dependence on ketamine that would lead to withdrawal, it can be abused.
Ketamine abuse can cause a serious bladder disease and memory problems, and the long-term effects of extended ketamine use are not well-understood, Heifets said. The Stanford professor advises against using the drug on a continuous basis.
Caplin describes the treatments as helping patients wrestling with depression get over a “threshold” of symptoms that are keeping them from pursuing their interests. He encourages all his patients to participate in activities they used to enjoy while they are receiving treatment.
Insurance companies typically don’t cover ketamine treatments for depression or PTSD because it was not originally approved for those treatments.
At the Four Corners Ketamine Center, a one-hour treatment session is $400 and six sessions recommended for depression are $2,400. Discounts are available for veterans and first responders.
mshinn@durangoherald.comThis story has been corrected to reflect that Four Corners Ketamine Center does not plan to allow patients to take nasal sprays of ketamine at home. The medication will be given at the center so patients can be monitored.