Major Depression

What is Major Depression?

Major depression is one of the most common mental health illness in the United States that if remains undiagnosed or untreated, can lead to significant increase in suicidal thoughts and/or attempts. In 2020, 21 million adults and 4.1 million adolescents had at least one major depressive episode in the United States. Only 66% of adults and 42% adolescents with major depressive disorder received conventional treatment in 2019. At least one third of the treated adults suffered from treatment resistant depression(TRD). Conventional therapies have been in use for several years but have poor response rate, poor compliance, long wait time to see improvement and unwanted adverse effects.

New NMDA receptor antagonists are bringing hope to the patients suffering from major severe depression, treatment resistant depression and bipolar disorder Type 2 with depression.

Traditional Treatments

1.     Oral anti-depressants

• Advantages: Low cost with insurance coverage, first choice therapy for years, easy to take at home.
• Limitations: Usually take 6-8 weeks to show improvement. Response rate is less than 50% and it further decreases with each failed medication. Unfavorable side effects leading to poor compliance and inadequate treatment courses.

2.     Electroconvulsive Therapy

• Advantages: Long tried and tested treatment, Insurance covered
• Limitations: Social stigma, retrograde amnesia (loss of memory), Usually low response rate

3.     Adjuvant therapies such as psychotherapy, Exercises, Meditation

• Advantages: Low/no cost, no side effects
• Limitations: Variable response rate and compliance, time consuming, only add on use.
  

Newer Treatments

1.     Trans-magnetic Stimulation

• Advantages: Low cost with insurance coverage, long lasting response if patient responds.
• Limitations: Time consuming 36 sessions leading to low compliance. Response rate is variable and it does take couple of weeks to see significant improvement.

2.     Ketamine Infusion Therapy

• Advantages: Response onset is usually 3-7 days (sometimes even less than 24-48 hours). Response rate with recommended NIMH protocol is 60-80%. Low dose supervised Ketamine therapy has favorable side effect profile. Patients can have reduction in their suicidal ideations/thoughts by 50% with a single IV ketamine infusion.
• Limitations: Patients have to go to the ketamine clinic for each IV ketamine session. It is expensive therapy without insurance coverage. Although highly effective, ketamine is not a cure. Patients have to receive maintenance ketamine session once a month after initial six sessions.
• The Science: Patients with major depression have decreased neuroplasticity and decreased synaptogenesis in their brain. Any trauma or stress can worse them further. Ketamine works as NMDA receptor antagonist on GABAergic inhibitory interneurons. By inhibiting inhibitory interneurons, It causes increase in glutamate release. Increased Glutamate tiggers release of brain-derived neurotrophic factor (BDNF). BDNF acts like a fertilizer to the brain land and plays significant role in rapidly improving neuroplasticity and synaptogenesis in the brain.. In simple terms, Ketamine causes remodeling/rewiring of the brain by creatinine more synapses and making brain more neuroplastic.
• New research: Yale researchers are undergoing first clinical trial to evaluate role of ketamine in depression associated with Parkinson's disease. FDA has recently approved the use of oral R-ketamine (non-psychedelic form) in a life science study that German psychedelic startup Atai Life Sciences have been pursuing to see effectiveness of R-ketamine in treatment resistant depression (TRD).

3. Auvelity: New rapid acting oral NMDA antagonist recently approved by FDA for use in major depression. It contains dextromethorphan and bupropion. Patient can see response as early as 1 week. Patient unfortunately can develop suicidal ideations/thoughts, panic attacks, insomnia and increased anxiety.  It is not recommended in children and in adults with seizure disorder and eating disorders such as anorexia nervosa and bulimia.

4 Psilocybin. it has shown promising results in phase II clinical trial and is currently undergoing Phase III Pivotal 1 trial.

Why Choose Ketamine Wellness Medical Practice?

• Each infusion is administered and supervised by our highly experienced ketamine specialists. Our practice follows NIMH protocol but as one size does not fit all, each patient receives the safest and most effective personalized ketamine infusion protocol. 
• We do understand that most patients and their family members likely have a busy schedule. To make sure ketamine sessions don't interfere with their work schedule, our practice does offer sessions in the evening and over the weekends.
• We focus on our patients to get better without worrying about committing to six sessions. Patient only pay for the session they receive.
• Provider signed documentation is available on the day of infusion if patient prefers to file the insurance claim for each ketamine session individually.
• Once our ketamine specialist approves the ketamine therapy, every effort is made to schedule new patients within a week.
• We are proud to say that we have not seen any major adverse reactions in any of our patients.
• Our treatment response rate in patients who have completed six ketamine sessions is above 80%. (National reported average is 60-70%)
• Recently, we have seen uptrend in partial insurance reimbursements to our patients. Our superbill provides all the necessary information that most insurances require to process the claims.

If you or someone you know is suffering from major severe depression or treatment resistant depression, you may be able to experience rapid relief. Please contact us now for a consultation to see if you would be an ideal candidate for ketamine infusions.