Ketamine has become a helpful and exciting option for many individuals who were resistant to other treatments for major depression and other difficulties. But how does ketamine work in the brain and how does it help for treatment resistant depression?
In the past, researchers believed that Ketamine increases dopamine transmission in multiple areas of the brain. However, a recent interdisciplinary study from Columbia University found more nuanced effects. Researchers uncovered decreased dopamine and brain cell activity in some areas of the brain in rats, but increased brain cell activity in other parts of the brain. Decreased dopamine transmission in certain brain areas supports the sedating effects long associated with this substance.
However, researchers observed increases in dopamine and brain cell activity in the brain’s cognitive centers, such as the prefrontal cortex (PFC). The PFC is helpful for cognitive flexibility and emotion regulation. Doses of ketamine in this research yielded improvements in cognitive behavioral aspects of mood, and thus decreases in depressive symptoms.
Importantly, this research found these effects in mild to moderate doses of the drug over extended periods of time, as opposed to single larger doses. Single large doses are often used in medical treatments for anesthetic or sedative purposes. Larger doses were also used in initial studies of the drug.
People have also typically used larger doses when taking ketamine recreationally. High levels often flood the brain with too much of the substance’s chemical effects. This flooding often leads to decreased consciousness, confusion, or dissociation (usually referred to as “the K-Hole”). However, researchers still do not fully understand these effects in the brain.
This study is helpful for understanding a key issue that frequently comes up with newer exciting treatment approaches: what works well for what?? Similar to caveats with psilocybin, ketamine tends to work for certain conditions, but not others. It appears to help treatment resistant depression, suicidal ideation, and chronic pain. Preliminary evidence suggests it may also help with PTSD.
Practitioners may sometimes use ketamine as a standalone treatment. However, clients also usually need therapy (the “…-assisted therapy” component) for the drug’s effects to lead to sustained change. Some prescribers use it along with traditional antidepressant medication (e.g., SSRIs like Prozac) to compound effects.
Ketamine is a promising treatment for many clients. New advances in brain research help us understand how it helps and at what doses. This understanding helps us treat it effectively and safely.
