Ketamine to Treat Treatment-Resistant Depression

沮丧is the second most common mental health disorder in the United States. 17.3 million (7.1%) U.S. adults have experienced at least one episode of抑郁症within a calendar year.

沮丧can affect your professional life and personal life and destroy your self-worth and ultimately wreak havoc on your life. Depression can affect anyone and everyone without a clear-cut reason.

治疗抑郁症通常是药物的组合，特别是抗抑郁药和心理治疗方法如认知行为疗法(CBT). Antidepressants,特别是选择性血清素再摄取抑制剂(SSRIs), take approximately four to six weeks to work.

Ketamine，致致治疗抗治疗抑郁症的致致剂抑郁型抑郁症。本文探讨了氯胺酮如何治疗抑郁症，其疗效及其潜在的副作用。

什么是氯胺酮？

在越南战争期间，在20世纪60年代作为士兵的麻醉药物引入了氯胺酮。如今，氯胺酮仅由处方合法，并在手术期间用于兽医药物。

It is aSchedule III drug根据毒品管制局(DEA), which means that it has medically accepted uses but also has potential for abuse, including physical and psychological dependence.

Ketamine is also classified as ahallucinogen.然而，氯胺酮非常松散地定义为致幻原子，因为幻锐的类也包括像这样的药物lysergic acid diethylamide（LSD），萨尔维亚,peyote,phencyclidine（PCP），以及psilocybin(mushrooms).

Ketamine, when administered as a prescription, has the potential to treat post traumatic stress disorders (PTSD), treatment-resistant depression, anxiety, and both chronic and severe pain.

Ketamine as an Illegal Drug

Ketamine serves a purpose in medicine when prescribed correctly, but it is also a commonly abused drug. Commonly referred to as "Special K" and "Cat Valium," Ketamine is sold illegally as a mind-altering drug that enhances or alters mood and perception.

麻醉性能也可以使个人感到麻木，这可能导致事故和严重损伤，而在氯胺酮的影响下。

Usually, the “high” lasts for less than an hour and can cause a state of utter bliss, also known as euphoria. In addition to the typical “out of body experience,” higher doses that are typically injected can lead to an effect known as the “K-hole.”

“K-hole” refers to a near-death, out-of-body experience, where the user is incapable of interacting with others.

Treatment-Resistant Depression

大约30%的重度抑郁症患者的症状在治疗后没有改善。一个人，谁不改善两个不同的抑郁症药物的足够剂量采取了至少六个星期的持续时间，是说有抗药性抑郁症。

It is difficult to determine who will have treatment-resistant depression, but research has shown that female gender and older age are risk factors for treatment-resistant depression.

Individuals who have chronic medical illnesses such as chronic pain and thyroid disorders are also at an increased risk for treatment-resistant depression and individuals who have a history of饮食失调,substance abuse紊乱，以及睡眠障碍.

有一些有效的治疗方法可以治疗这种类型的抑郁症，还有一些新的研究正在进行中。

氯胺酮作为抑郁症的治疗方法

食品和药物管理局（FDA）批准氯胺酮，根据eskakamine（由制造商称为“Spravato”）在2019年春季进行治疗抑郁症。

在FDA批准之前，氯胺酮已经作为一种非处方药用于治疗这类抑郁症多年了。氯胺酮不能像抗抑郁药那样针对大脑活动fluoxetine（百忧解），文拉法辛(Effexor), andsertraline(Zoloft). Rather, it blocks a receptor called N-methyl-D-aspartate, or NMDA.

Researchers are still not certain why some people with depression respond to ketamine and others do not. Still, without FDA approval, this drug has been used for “off label” uses in individuals with treatment-resistant depression, pain management, and palliative care.

Before ketamine was FDA-approved for treatment-resistant depression, ketamine was administered intravenously. Following its approval by the FDA, individuals can administer it themselves as a nasal spray under medical supervision.

氯胺酮是如何施用的

现在，氯胺酮在品牌名称下，Spravato是FDA批准的，有严格的指导原则作为抑郁症治疗。Spravato以鼻喷雾给药，仅在特定的氯胺酮诊所和药房中提供。

难治性抑郁症患者在医生办公室给自己服用氯胺酮，在办公室等待两个小时的监护，然后被送回家。这样，当个人受到氯胺酮的影响时，总是处于监督之下，特别是因为它的离解特性。

IV ketamine, also known as ketamine infusions, is not approved by the FDA but is still used as an off-label medication in Ketamine clinics for treatment-resistant depression, chronic pain, anxiety, and trauma.

在40分钟的持续时间内以缓慢，受控速率施用静脉酮胺。输液剂量根据个体的重量计算并根据其可耐受性进行调整。治疗过程包括3至4周内的6至8个输注。

氯胺酮治疗难治性抑郁症已显示出积极的效果

氯胺酮是治疗抗抑郁抑郁症的有希望的治疗，并显示出抑郁和自杀素的阳性结果。因此，这种药物给那些一直争夺萧条的人带来了希望，并给他们一个重大改善的窗户。

这个窗口可以允许其他干预,including psychotherapy, to be implemented. Psychotherapy is an integral part of treatment for depression. Still, when individuals are extremely depressed, they usually cannot engage in psychotherapy in a meaningful manner, which can be too much of a psychological burden for them.

Ketamine is a medication that can potentially help alleviate depression rapidly, which can allow meaningful psychotherapy engagement for the long-term healing process.

Ketamine Clinics

如果你在网上搜索引擎中输入“氯胺酮诊所”或“氯胺酮输注”，你将被淹没在你的地理区域内无穷无尽的氯胺酮治疗诊所。

在过去的几年里，氯胺酮诊所在美国迅速发展。从2015年到2018年，诊所的数量从60增加到300;今天这个数字要高得多，特别是因为氯胺酮现在是FDA批准用于治疗抑郁症。

Ketamine clinics are the new “methadone clinics” and are advertised to treat individuals with depression, anxiety, PTSD and pain disorders. These high-profit clinics are popping up all over the country to treat mental health conditions while simultaneously turning a high cash profit. Yes, they are controversial, but not all ketamine clinics are created equal.

For instance, some clinics don’t thoroughly screen patients for treatment-resistant depression or suicidal ideations and will potentially offer the medication for anyone who is willing to pay.

诊所可以从350美元到每次输液1000美元的任何地方收取，许多人至少获得六轮待遇。一些诊所没有内部精神病学家或其他工作人员的精神卫生专业人士，并非所有诊所都与患者的主要心理健康提供者合作。万博手机客户端

氯胺酮治疗前要知道什么

Although not an official guideline, the APA issued a statement that was published inJAMA Psychiatryin 2017. The APA recommended that before treatment, a doctor should:

• Perform a comprehensive assessment of the individual’s depressive symptoms and check for a history of substance abuse or other psychiatric disorders, including suicidal thoughts.
• Confirm that standard treatments for depression were not effective for the individual.
• 评估个人的整体健康和该人为氯胺酮治疗的可能风险。

Because some clinics do not operate under proper protocols, if you are looking for a ketamine clinic to help with your treatment-resistant depression, you'll want to keep the following guidelines, listed below, in mind:

• 评估
• 经验
• Administration and monitoring
• Cost

评估

• 是谁actually evaluating youand determines if this treatment is appropriate for you?
• 这个人是否基于评估？
• 他们在评估中花多少时间？
• Do they communicate with your primary care physician or mental health therapist?
• 它们如何解决滥用药物？
• Is the physician who does the evaluation the same physician who provides treatment?

经验

• 提供氯胺酮治疗的医生是否专业能够对待你的病情？换句话说，这位医生是一位精神科医生，专门治疗严重情绪和焦虑症吗？
• What is the extent of the provider’s ketamine infusion experience?
• 询问数字，结果，无论他们是否保留自己的患者数据和结果的登记，他们如何在治疗过程中以及后来在治疗过程中遵循结果，以及他们如何与其他人对待您的其他人协调。

行政和监测

• Is the route for administration of ketamine specifically IV?
• 氯胺酮是用电脑输液泵注射的吗？
• Is the dose adjusted during infusions or throughout the treatment course?
• 多久给药一次？
• 调整是否标准化或有所不同？
• 是否对您的生命体征进行持续监测？
• 您如何在治疗期间和之后在心理上监测？

Cost

• 这种治疗成本是多少，您的保险提供了保险？
• How many rounds of ketamine are recommended?

What Interferes With Ketamine Treatment

以下是可能干扰氯胺酮治疗的条件和行为列表：

• 活性物质滥用（酒精，大麻，非处方药，处方疼痛药物等）
• 历史psychosis
• 历史increased intracranial pressure
• Current pregnancy
• 不受控制的高血压
• 急性或不稳定型心脏病
• A previous negative response to ketamine

Ketamine Side Effects

与所有非处方药或处方药一样，氯胺酮确实有潜在的副作用，在开始氯胺酮治疗之前，应告知每个人这些副作用：

• 心跳加速
• 高血压
• 自发发声
• Confusion
• Hallucination
• 肌肉颤栗
• Increased muscle tone
• Drowsiness
• 记忆丧失

瘾势

Like opioids, also known as prescription painkillers, ketamine has addictive properties and can result in substance use disorders in certain individuals or when it's misused.

用抗治疗抑郁症来换取上瘾可能是一个危险的滑坡。虽然诊断不能仅仅基于身体症状，但这些可能是一个警告信号，表明你或你所爱的人正在与氯胺酮成瘾作斗争：

氯胺酮问题的危险信号包括：

• 慢性咳嗽，如果药物是烟熏的
• 如果它哼了一下鼻子或流鼻血
• Skin wounds and track marks if it is injected
• 饮食、卫生和睡眠模式的变化
• 对痛苦刺激的反应减少
• 瞳孔散大
• Increased saliva and tear production
• Extreme sleepiness
• Slurred speech
• 僵硬的肌肉
• 无法控制和快速的眼睛运动

治疗“全人方法”

沮丧is a common mental health disorder that is best treated using a multitude of treatment options.

沮丧is best treated when we understand the individual, his or her underlying triggers, and by offering this individual a multidisciplinary approach to treating them.

管理个人心理健康或药物滥用障碍的跨学科方法包括药物和心理治疗以及辅助策略，如瑜伽和改变生活方式。万博手机客户端

Treating depression (or any mental health or substance abuse disorder) is not a “one-stop-shop,” meaning that it often takes a village and a combination of different modalities and approaches to find the best treatment plan for each individual.