Effective home ketamine therapy for treating anxiety and depression

  • Ketamine therapy at home is a safe and effective way to relieve symptoms associated with anxiety and depression, according to the results of the largest clinical study ever conducted on ketamine therapy.
  • Home therapy using ketamine tablets that dissolve under the tongue could make ketamine therapy more accessible than when given intravenously or intramuscularly in a clinical setting.
  • Although some people may experience relief from anxiety or depression with ketamine therapy, experts warn that more research is still needed to better understand how it compares to traditional treatments.

Multiple sessions of home ketamine therapy supported by telehealth are a safe and effective way to treat moderate to severe anxiety and depression, a new study has found.

The results, recently published in the Affective Disorders Diarysuggest that a home approach using ketamine tablets that dissolve under the tongue rather than an intravenous (IV) infusion or intramuscular injection could make ketamine therapy more accessible.

But experts warn that more rigorous studies are still needed to determine how well ketamine therapy compares to traditional treatments for anxiety and depression.

Ketamine, once primarily used as an anesthetic, is gaining traction as a potential treatment for depressive disorders and suicidal thoughts in a clinical setting.

Healthcare professionals can administer ketamine directly into a vein (intravenously or IV) or into a muscle (intramuscular injection) in a clinical setting.

The Food and Drug Administration (FDA) also recently approved esketamine, a form of ketamine administered with a nasal spray. Esketamine therapy can be used in combination with an oral antidepressant for the treatment of depression in people who have not benefited from antidepressants alone.

In addition, ketamine tablets can also be dissolved under the tongue (sublingual), which was shown to improve symptoms in people with treatment-resistant depression. (Sublingual ketamine therapy was used in the new study).

In the current study, which was the largest clinical study of its kind to date, more than 1,200 adults received sublingual ketamine therapy at home through spirit flowera telehealth platform that offers this therapy in 30 US states.

All participants included in the study were diagnosed with severe anxiety, moderate to severe depression, or both.

Prior to their first medication session, participants met with a psychiatrist via video call. The clinician assessed people to see if ketamine therapy would be right for them.

“While home ketamine sublingual therapy may be an effective and safe treatment option for people with anxiety or depression, it is not suitable for everyone,” the study author said. , the doctor. Leonard Vando, medical director of Mindbloom. “That’s why Mindbloom clinicians play a vital role in determining whether treatment is appropriate for each potential client.”

Throughout the study, participants met with a behavioral coach who helped them prepare for their first session and provided support between sessions, including via text.

The home therapy protocol included four weekly medication sessions. During each session, participants dissolved the ketamine tablet under their tongue, put on an eye mask, and listened to music for an hour. Then they wrote in a journal about the experience, which helped them reflect and integrate their feelings and ideas.

As a precaution, study participants were also given a digital blood pressure cuff so they could monitor their blood pressure after taking the drug, as ketamine can raise blood pressure.

After four medication sessions, almost 89% of people saw an improvement in their symptoms of anxiety or depression, either immediately or after the first two sessions.

Overall, almost 63% of people experienced a reduction of 50% or more in their symptoms of anxiety or depression. Additionally, the researchers found a decrease in the number of participants who reported having suicidal thoughts or ideation.

Side effects from ketamine treatment were rare, reported by less than 5% of participants. Only four people discontinued treatment due to adverse events.

“This study demonstrated that home treatments can be incredibly effective with a low rate of side effects, especially compared to SSRI studies. [selective serotonin reuptake inhibitors]”, Vando said. (SSRIs are commonly prescribed antidepressants and include Celexa, Prozac and Zoloft.)

Subhdeep VirkMBBS, a clinical associate professor of psychiatry and behavioral health at Ohio State University Wexner Medical Center in Columbus, who was not involved in the new study, said one of the strengths of the research was the large number of participants.

Still, she noted that the study is just a “starting point” and called for more research, especially a placebo-controlled randomized clinical trial (RCT). This type of study would allow researchers to compare the safety and effectiveness of home ketamine therapy to standard treatments for anxiety, depression, or both. In the new study, there was no control (or comparison) group.

Virk added that following patients longer — 1 to 6 months after treatment ends — would also provide insight into the long-term benefits of ketamine therapy at home. “We have a lot of data on ketamine,” she said. “We already know that it helps much faster than some of the other antidepressants. What we don’t know about this treatment is how long these effects last.

In her clinic, Virk said she provides both intravenous infusion and intranasal ketamine therapy to patients, so she knows of its potential as a treatment for anxiety and depression. However, as this is a newer treatment, she tells patients she is “cautiously optimistic” about ketamine’s role as a treatment.

“We are definitely seeing results – if you compare ketamine to traditional antidepressants, the response is faster,” she said. “But it’s not a miracle cure. It has its limitations, and we must always be careful in selecting patients when offering these treatment options. »

Throughout the pandemic, telehealth has increased access to many types of medical care. Some researchers are hopeful that internet-based health care offerings will continue and help provide more equitable access to care.

dr. David A. Merrilladult and geriatric psychiatrist and director of the Pacific Neuroscience Institute’s Pacific Brain Health Center, said the new study not only shows the value of sublingual ketamine therapy, but also how to successfully integrate telehealth into a treatment program.

“It was a good demonstration of the added value of telehealth that we gained from the experience of the pandemic where we needed options to treat people remotely,” Merrill said.

The positive results of the study suggest that the home approach to ketamine treatment may increase access to this therapy for people with anxiety and depression.

Merrill agreed that the results look promising. He added that home ketamine therapy could potentially provide a safe and effective option in areas where effective treatment options are limited and access to care is increasingly difficult.

“If the costs can be borne, this is another potential way for patients to get treatment for crippling anxiety and depression,” Merrill said.

According to the study authors, sublingual ketamine costs between $200 and $250 per treatment dose, which is cheaper than ketamine IV infusion.

However, they also noted that few health plans cover the cost of ketamine treatment for depression and anxiety. This means that patients would have to pay out of pocket, which could limit the reach of this therapy.

This, Merrill says, is another reason why more rigorous clinical trials are needed.

“I hope these preliminary results will be used to design [RCTs] and gather the evidence needed to convince insurance payers to not only cover long-term telehealth, but to cover things like ketamine-assisted psychotherapy, whether at home or in the office,” he said. -he declares.

While more and more research shows the potential of different ketamine therapies as a treatment for mental health issues like anxiety and depression, medical experts agree that more rigorous studies are still needed to determine the long-term efficacy of ketamine.

If at-home ketamine sublingual therapy continues to be effective, it could pave the way for a more cost-effective approach to using ketamine for therapeutic purposes.

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