Summary: One of the most extensive studies to date shows that sublingual ketamine combined with telehealth is even better than clinically administered IV ketamine for anxiety and depression. Ketamine provides quick relief from mood disorders and helps rewire the brain for prolonged relief, while most other medications take a long time to help and require prolonged therapy. Mood disorders like anxiety and depression are the leading cause of disability, and many studies confirm the efficacy of ketamine IV therapy in depression.
Ketamine is a medication initially developed as an anesthetic for surgical procedures. However, in recent years, it has gained attention for its potential use in managing mood disorders like anxiety and depression. Ketamine acts on a specific type of neurotransmitter receptor in the brain called the N-methyl-D-aspartate (NMDA) receptor. This unique mechanism of action sets ketamine apart from traditional antidepressants like selective serotonin reuptake inhibitors (SSRIs). It has led to its exploration as a novel treatment option for individuals who have not responded well to these traditional treatments. Currently, the FDA has approved ketamine for use in the management of treatment-resistant depression and as an anesthetic in medical procedures. However, ongoing research is examining the potential use of ketamine for a wider range of mood disorders, including anxiety and post-traumatic stress disorder (PTSD). A growing body of evidence suggests that ketamine may be a safe and effective treatment option for these conditions, particularly in individuals who have not responded well to traditional treatments. One promising approach to the delivery of ketamine treatment is through telehealth. Telehealth has some unique benefits. This approach to care has become increasingly popular in recent years as a way to improve access to care and reduce healthcare costs. For individuals with mood disorders, telehealth offers a convenient and effective way to receive treatment in the comfort of their own homes while also receiving ongoing support and monitoring from their healthcare provider.
Does sublingual ketamine work for depression and anxiety?
In the last decade or so, there has been a considerable increase in the use of ketamine for treating mood disorders. There is a reason why researchers are so interested in ketamine. To date, most drugs used to manage anxiety and depression increase the brain’s serotonin levels. These drugs start acting slowly over weeks and even months. These medications only work when taken daily and indefinitely, causing many adverse effects. However, some new studies show that ketamine is quite different from the existing antidepressants. Early studies show that ketamine infusion can help provide prolonged relief from depression and anxiety. It seems that ketamine helps rewire the brain, especially when combined with cognitive behavioral therapy. However, ketamine infusion has one significant drawback: it can only be provided in clinics. Hence, in recent years, researchers have started exploring the role of oral ketamine therapy in managing mood disorders. The sublingual route is of particular interest, as it offers the benefits of quick effect. Moreover, when drugs are taken sublingually, they are able to bypass first-pass metabolism. The new study is one of the most extensive clinical trials regarding the use of sublingual ketamine for managing depression and anxiety. The study was done on 1,247 patients. The study had some remarkable findings. It found that sublingual ketamine reduced the severity of anxiety and depression in 89% of patients. What is especially outstanding is that 63% of the participants reported more than a 50% reduction in their symptoms. Also, 30% of all the participants achieved complete remission just after four sessions for depression and anxiety. This means they had virtually no symptoms. The benefits of sublingual ketamine therapy were especially outstanding in patients with suicidal ideation. At the beginning of the study, 62% of those living with depression had suicidal thoughts. And at the end of the study, none had a suicidal thought. These findings are encouraging in many ways. These results are much better than those achieved by other medications and talk therapy and are even better than the results achieved by ketamine IV therapy. It appears that sublingual ketamine therapy combined with telehealth and remote patient monitoring is one of the most effective ways of managing mood disorders. Of course, there is still a need for more studies before sublingual ketamine can be approved for managing mood disorders. There is also a need for more extensive and prolonged studies to identify the long-term safety and benefits of such therapy. It is worth exploring if, in the long run, those living with depression and anxiety can be cured through such an approach.
Frequently asked questions
Does sublingual ketamine work for depression?
In one of the largest studies to date, 1,247 patients with moderate to severe anxiety and depression took ketamine under the tongue with telehealth support. Symptoms eased in 89% of them, 63% reported their symptoms cut by more than half, and 30% reached remission after four sessions. Longer and larger studies are still needed to confirm the long-term safety and benefit.
What is the difference between sublingual and IV ketamine?
IV ketamine is given as an infusion, so it can only be provided in a clinic. Sublingual ketamine dissolves under the tongue. It acts quickly and bypasses first-pass metabolism, meaning the drug skips the liver’s first round of breakdown. Because it does not need an IV line, it can be paired with telehealth and remote patient monitoring.
How does ketamine work for depression?
Ketamine acts on the NMDA receptor in the brain, a different target from SSRIs and other antidepressants that raise serotonin. It was first developed as an anesthetic for surgery. Because it works differently, it is being explored for people who have not responded well to traditional treatments. It also appears to help rewire the brain, especially when combined with cognitive behavioral therapy.
How fast does ketamine work for depression?
Much faster than the usual medications. Most drugs for anxiety and depression raise serotonin and take weeks or even months to help, and they work only while taken every day. Ketamine provides quick relief from mood symptoms. In the sublingual ketamine study, 30% of participants reached complete remission after just four sessions.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
