Understanding Treatment-Resistant Depression  

Treatment-resistant depression (TRD) is a form of major depressive disorder (MDD) that does not respond to at least two different antidepressants administered at adequate doses and durations [1]. TRD affects approximately 30% of individuals diagnosed with MDD [1], presenting a significant challenge in mental health care. Symptoms of TRD are often more severe and persistent, including prolonged depressive episodes, anhedonia, anxiety, and suicidal ideation [1]. 

The Promise of Ketamine 

Ketamine, originally developed as an anaesthetic, has emerged as an effective treatment for TRD [2]. Unlike traditional antidepressants that primarily target serotonin, norepinephrine, or dopamine pathways, ketamine works by blocking the NMDA receptor, affecting glutamate, which is a key neurotransmitter involved in mood regulation. This unique mechanism allows ketamine to rapidly alleviate depressive symptoms, often within hours to days. 

In clinical trials, ketamine has demonstrated a success rate of 55-70% for patients with TRD [2] [4]. A study involving 403 patients found that 55% of those receiving ketamine treatment experienced a sustained improvement in depressive symptoms [2]. Additionally, ketamine therapy has shown rapid onset of action, with many patients reporting significant improvements within hours of administration [4]. 

Ketamine's impact on the brain extends beyond neurotransmitter modulation. It also influences other important brain chemicals known as neurotropic factors, and particularly brain-derived neurotrophic factor (BDNF). BDNF plays a crucial role in neuroplasticity, the brain's ability to adapt and repair itself [5]. Studies have shown that ketamine can increase BDNF levels, which promotes synaptic growth and strengthens neural connections [5]. This enhancement of neuroplasticity is believed to contribute to ketamine's rapid and sustained antidepressant effects [5]. Through this process the brain forms new connections or synapses and strengthens existing ones, particularly in the medial prefrontal cortex which is an important region when it comes to emotion regulation. These changes help the brain release from entrenched thought patterns, making it more responsive to psychotherapy and other treatments. Enhanced neuroplasticity also supports cognitive recovery, and adaptability, providing a robust foundation for mental health improvement. 

Intranasal Spravato 

Spravato (esketamine) is an TGA-approved and PBS listed nasal spray specifically designed for adults with TRD and MDD with acute suicidal ideation or behaviour. Administered in a strict healthcare setting, Spravato offers a rapid delivery system that can significantly reduce depression symptoms within hours. Patients typically receive the treatment twice a week for about four weeks, followed by a tapering schedule. 

Precision Psychiatry at Brain & Mind Hub 

At Brain & Mind Hub, we leverage cutting-edge brain biomarkers to tailor treatment plans to each individual's unique needs. This precision approach ensures that patients receive the most effective therapies based on their specific needs. Ketamine and Spravato are integral to our treatment offerings, providing hope to those who have not found relief with traditional medications. 

An Upbeat Future 

The integration of ketamine therapy into our precision psychiatry model represents a significant advance in the way we treat TRD and offers hope for patients, clinicians, and the broader medical community. By harnessing the power of innovative treatments and personalised care, Brain & Mind Hub is transforming mental health care on the Sunshine Coast. We invite you to join us on this journey towards a brighter, healthier future. 

References 

[1] How Does Ketamine Affect The Nervous System | Anormed UK 

[2] Ketamine found effective in treatment-resistant depression 

[3] https://doi.org/10.1371/journal.pmen.0000215 

[4] Ketamine Statistics On Use & Abuse - Addiction Group 

[5] Brain-derived neurotrophic factor (BDNF) changes in rodent ... - Springer