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Ketamine

What is Ketamine?

Ketamine is a medication mainly used for starting and maintaining anesthesia. It induces a trance-like state while providing pain relief, sedation, and memory loss. Other uses include for chronic pain and for sedation in intensive care. Heart function, breathing, and airway reflexes generally remain functional. Ketamine is a drug that serves multiple purposes, it affects multiple pathways in the brain. Interacting with the glutamate system in our brain, it blocks glutamate receptors. Glutamate plays a role in neuron communication, so hindering their reception will create the anesthetic effect in the brain. Similar to how naltrexone interacts with opiate receptors, low doses of ketamine may actually increase production of the neurotransmitter it inhibits.

Ketamine Therapy

At lower doses, ketamine has shown potential to help with pain, depression, and other mental health issues. Upon taking ketamine, the effects can be felt immediately. This is opposed to other medications, such as Selective Serotonin Reuptake Inhibitors (SSRIs), that may be used to treat depression. While the SSRIs need time to build up in your brain, ketamine will begin to affect the neurotransmitter activity in your brain once administered. Today, SSRIs (drugs that increase serotonin levels) rank among the most prescribed psychiatric medicines. Serotonin is thought to increase the sense of well-being. SSRIs have had negative side effects, however, sometimes increasing the risk of suicide in some patients, diminishing libido in others, and often taking weeks to work. But the major problem with SSRIs and the other antidepressants is that, as a group, they fail to help about one-third of patients who try them.

This is why there’s so much excitement around ketamine. It offers relief to many patients who previously didn’t respond to anything. When it works, the drug acts within hours, not weeks, which makes it especially promising for patients at risk of suicide. And because it targets a different neurotransmitter system (not serotonin but glutamate) it’s giving scientists new insight into the biology of depression and other mental health disorders. See how ketamine can help with different disorders.

Ketamine for Depression

Recent breakthroughs in ketamine research highlight the positive effects it has on people with depression. Particularly for people who have tried other anti-depressants and failed. Ketamine works differently within the brain compared to SSRIs that are commonly prescribed to treat depression. Ketamine, once administered, works very quickly. The antidepressant effect of ketamine is detectable 40 minutes after the dose is given. A 2014 study provides controlled evidence of “significant improvement in depressive symptoms within 24 hours after ketamine compared to placebo.” Intranasal ketamine showed minimal psychotomimetic or dissociative effects. With a proper ketamine implementation strategy, this drug can help the brain foster new neuron connections and provide long-term alleviation.

Ketamine for Chronic Pain

Ketamine has also been shown to have positive effects on chronic pain syndromes. Though the exact process has not been mapped out, ketamine influences pain in a variety of ways. Primarily, ketamine acts as an N-methyl-D-aspartate (NMDA) receptor inhibitor. Neurogenic pain is greatly influenced by the NMDA-receptor system and, “antagonizing this system may be a useful way to obtain better pain control.” Ketamine also has anti-inflammatory effects as well as enhances the descending inhibition of pain. Studies have shown that infusion from 4-14 days can lead to long-term analgesic effects for up to 3 months. Some side effects include, “psychedelic symptoms (hallucinations, memory defects, panic attacks), nausea/vomiting, somnolence, cardiovascular stimulation and, in a minority of patients, hepatoxicity.” However, some studies have shown benzodiazepines are able to reduce the psychotropic side effects.

Ketamine for Anxiety

A recent study looked into the effectiveness of ketamine in treating social anxiety disorder. 18 adults who were diagnosed with DSM-5 social anxiety disorder were in a randomized, double-blind trial in which intravenous ketamine and a placebo were given to the participants. After two weeks, participants had a significant anxiety reduction when measured by the Liebowitz Social Anxiety Scale (LSAS). This gives us initial evidence that ketamine may be able to help patients with anxiety, especially if they have tried other medications and failed.

How Do You Take Ketamine?

Ketamine as an analgesic can be administered intravenously. Compounding pharmacies, however, can compound the drug in a variety of ways. Nasal sprays are a common way to take ketamine. The FDA has approved SPRAVATO® as the first traditionally prescribed ketamine nasal spray. Patients will need to use the nasal spray in office under the supervision of their doctor. 

However, if the patient requires a different dosage size they may turn to a compounding pharmacy. We are able to provide a dosage size that may not be available commercially. If the patient is not a great risk for addiction, they may also take their compounded ketamine in the comfort of their own home. This is helpful for clients who may require lower doses of ketamine. Additionally, we can change the way the medication is delivered. This means in addition to nasal sprays we can make ketamine troches, sublingual drops, and even pain creams.

Ketamine Compounded Forms

Nasal Spray

Intranasal ketamine is not commercially available, but the clinical use of intranasal ketamine is increasing internationally. Research has concluded that the drug formulation, the delivery device, the technique, and individual patient factors play an important role in tolerability and efficacy when using intranasal ketamine for Treatment-Resistant Depression. Intranasal ketamine has been reported in studies to help depressed patients who have not responded to conventional therapy with minimal side effects.

Rapid Dissolve Tablet

Few compounding pharmacies make rapid dissolve tablets (RDTs). RDTs do exactly what the name suggests, they dissolve very easily once taken by mouth. This is great for patients that may struggle with swallowing pills. RDTs are also better tasting. RDTs avoid the digestive system and deliver the medicine directly to the body.

Troche

Troches are small tablets that serve as a vehicle for delivering medication to the body. They are similar to cough drops in consistency and size. Troches can be compounded to contain the medication required by the client. They dissolve in the mouth, though not as fast as RDTs. This allows the medicine in the troche to also bypass the digestive system and enter the bloodstream directly.

Pain Creams

Pain creams help address pain at the source location. Ketamine can be compounded as an active ingredient in a transdermal solution. Applying a ketamine cream can help alleviate symptoms of neuropathic pain and complex regional pain syndrome. Topical ketamine also provides the upside of having no serious side effects while having higher concentrations of ketamine.

Is Ketamine Right for You?

Continued research on the effectiveness of ketamine continues to bring positive results. For those who have tried other medications to no avail, ketamine may be a reasonable option. ClearSpring Pharmacy can compound ketamine to fit the required form and dosage! Our products are tested to assure that our patients are getting the most efficient and potent product. Additionally, our pharmacists will also help you navigate your ketamine usage so that you can be sure that you are taking your medications appropriately. Please feel free to call our Littleton or Denver locations, we are always happy to help! Or fill out the form on this page and we will provide a prompt response. Additionally, you can easily text our pharmacy with any questions you may have: Littleton: 303-707-1500 Cherry Creek: 303-333-2010 You can also send us a message through any of our social media channels. We make it easy to connect!

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