Immersion

Does ketamine help treatment-resistant depression?

Short answer

Early research says yes, with a catch. In people whose depression has not responded to other treatments, a single ketamine infusion can lift symptoms within a day, far faster than a usual antidepressant. But the relief often fades within a few weeks, so it works best as the start of a plan, not a one-time fix.

The research
Murrough, J. W., Iosifescu, D. V., Chang, L. C., Al Jurdi, R. K., Green, C. E., Perez, A. M., Iqbal, S., Pillemer, S., Foulkes, A., Shah, A., Charney, D. S., and Mathew, S. J. (2013). Antidepressant Efficacy of Ketamine in Treatment-Resistant Major Depression: A Two-Site Randomized Controlled Trial. American Journal of Psychiatry, volume 170, issue 10, pages 1134 to 1142.
Sample 73 adults with treatment-resistant depression in a two-site randomized controlled trial
Published 2013
Journal American Journal of Psychiatry
James Murrough and colleagues ran a randomized controlled trial of ketamine for treatment-resistant depression, meaning depression that had not improved after other treatments. They enrolled 73 adults across two sites and compared a single ketamine infusion against a single infusion of an active placebo, a sedative chosen because it feels similar going in, so that neither the patients nor the raters could easily tell the two apart. Depression was measured with a standard clinician-rated scale, the Montgomery-Asberg Depression Rating Scale, where a higher number means more severe depression. Twenty-four hours after the infusion, the ketamine group had fallen about 8 points further on that scale than the placebo group. Put another way, 64 percent of the ketamine group had responded at 24 hours, meaning their depression had at least halved, compared with 28 percent of the placebo group. The effect was rapid, arriving within a day rather than the weeks a typical antidepressant takes. The authors were careful about the limits. They measured a single infusion at one day out, and they wrote plainly that more information on how long the response lasts, and on safety, was needed before the treatment could be relied on in everyday care.
Read the paper

What does this mean for you?

Here is the plain version. The headline is real: ketamine can lift depression fast, often within a day, in people who were not helped by standard treatments. That is unusual. Most antidepressants take weeks to do anything, so a response measured in hours is part of why ketamine changed how doctors think about hard-to-treat depression.

But speed is only half the story, and the honest half is harder. The relief tends to fade. In a separate study by the same group, 24 adults with treatment-resistant depression received a series of up to six infusions over about two weeks. Roughly 71 percent responded, which is encouraging. Yet among the people who responded, the depression came back fairly quickly once the infusions stopped. The typical time to relapse was around 18 days. So a single course is better understood as a rapid, temporary lift than as a lasting repair.

That is why the research has moved toward keeping the response going rather than chasing one dramatic session. A later trial of a nasal-spray form of ketamine, called esketamine, taken together with an ongoing antidepressant, found that people who stayed on it relapsed less often than people switched to a placebo spray. The shape of the treatment is becoming clearer: a fast start that needs a plan to hold it, not a fix delivered in an afternoon. It is worth knowing that the spray trial was funded by the company that makes it.

A plain caution runs through all of this. Ketamine for depression is given in supervised medical settings, by clinicians who watch over you, partly because it can cause short-lived effects like feeling detached from your body or surroundings, a state called dissociation. These are not treatments people safely arrange on their own, and the studies here are small and early. The fair reading is this: a fast, real, but short-lived effect, most valuable as the opening of a longer plan rather than the whole of it.

The takeaway

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Dissociation Integration Between-session support

This is the work Asendar™ was built for: the stretch after a fast-moving treatment, when the hard part is holding on to a gain and noticing early when it starts to slip. If you want a simple read on where your head is today, take your Mental Readiness Score.

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People also ask

How fast does ketamine work for depression?

Fast, by the standards of depression treatment. In the two-site randomized trial, the benefit showed up within 24 hours of a single infusion, with 64 percent of the ketamine group responding at one day against 28 percent on an active placebo. A standard antidepressant usually takes weeks to help, so the speed is the striking part.

How long do the effects of ketamine last?

Often not long on their own. In a study of repeated infusions over about two weeks, most people responded, but among those responders the depression typically returned around 18 days after the last infusion. That short window is why clinicians focus on a plan to maintain the response rather than a single treatment.

Does the improvement last after the treatment stops?

Not reliably by itself, which is why maintenance matters. A trial of a nasal-spray form of ketamine, esketamine, taken together with an ongoing antidepressant found that people who continued it relapsed less often than those switched to a placebo spray. Holding the gain takes an ongoing plan, not one treatment. That trial was industry funded, which is worth keeping in mind.

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