If you’re dealing with depression, remember you’re not alone. Millions of people worldwide struggle with clinical depression, also known as  major depressive disorder (MDD), While conventional antidepressants are effective for many, it's common for individuals to experience only partial relief, even after trying multiple medications. It can be disheartening when traditional treatments don't offer the level of relief you're seeking. But we’re here to help. Ketamine, a promising and innovative treatment, provides new hope for those suffering from depression.

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So, how does ketamine work for depression, and how does it compare to traditional treatments?

We’ll provide the answers you need to make informed decisions about managing your depression and embark on your journey to a brighter, more fulfilling future.

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Limitations of Traditional Treatments

Traditional treatments for depression, such as Selective serotonin reuptake inhibitors or SSRIs, have limitations and may not be fully effective for everyone. These medications, which became popular in the 1990s, are often the first line of treatment but can lead to delayed or limited responses.  Moreover, around 30% of patients with major depression disorder have what is known as "treatment-resistant depression" or TRD and do not respond adequately to multiple attempts with traditional antidepressants.

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Ketamine as a Promising Treatment for Depression

With the limitations of conventional antidepressants, there is a pressing need for alternative, faster-acting treatments that can complement existing therapies. Ketamine, a widely used anesthetic with psychoactive properties, has garnered significant attention for its rapid action on depressive symptoms. With this increased interest, numerous studies have been conducted to investigate the impact of ketamine on depression, with results showing significant promise.

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How Does Ketamine Work for Depression?

The Science Behind Ketamine and Depression

Unlike conventional psychiatric medications, ketamine is a unique antidepressant that targets different areas of the brain. It primarily affects the control centers for your emotions, helping you reconnect with your deepest self. Ketamine does this by activating a brain chemical called glutamate, which promotes neuroplasticity - the process by which your brain adapts, makes changes, and learns new things.

However, we don't fully understand the entirety of how ketamine works yet. More research in neurobiology, the scientific field that studies the nervous system and brain function, is needed. Some experts believe that ketamine might work by blocking certain parts of your brain, like the NDMA receptor, which helps with memory. This activity could lead to quicker communication between brain cells, a process similar to how your brain grew when you were a baby or a young child. With this, ketamine is an exciting, new type of antidepressant, especially when used alongside psychotherapy for treating depression.

The Immediate Effects of Ketamine

Ketamine has immediate effects that last weeks after a single dose. Importantly, it provides a fast-acting antidepressant and anti-suicidal benefit, providing temporary relief from depression. This quick improvement can be vital in severe cases. Ketamine’s rapid relief creates a favorable neurochemical environment that offers a chance for creating long-term change while waiting for conventional treatments to take effect. One study found that depression symptoms improved immediately after administration of ketamine and lasted for an entire month. When used alongside psychotherapy, ketamine offers a window of opportunity to reinforce new neural connections through skill-building, making it a promising solution for lasting relief from depression.

Long-Term Relief from Depression

It's important to note that while ketamine may offer quick relief, these effects are temporary and tend to fade shortly after treatment. After 2-3 weeks of regular ketamine treatment, patients often experience a return of depressive symptoms. Ketamine-assisted psychotherapy (KAP) offers a beacon of hope for long-lasting results, especially for those who haven't found relief with other treatments. This integrated approach combines the power of ketamine's ability to help your brain adapt and grow with intensive psychotherapy, guiding you toward a path of sustainable recovery. One study revealed that KAP resulted in sustained reductions in depression and other mental conditions, with symptom improvement lasting well beyond the duration of dosing sessions and effects lasting up to 5 months.

Types of Ketamine Used for Depression

There are different ways to use ketamine to help those suffering from depression. Each method involves a different form or administration route of ketamine. Let's explore these different types of ketamine and how they are currently being used today.

Ketamine and Esketamine Nasal Sprays

Both ketamine and esketamine (Spravato) are used in the treatment of depression, but they differ slightly. Ketamine is the generic form and is used off-label for depression. Esketamine, on the other hand, is specifically FDA approved for the treatment of depression. Both are available as nasal sprays, with intranasal administration resulting in a 45-50% bioavailability (absorption rate).  Typically, two treatments per week are given for the first four weeks, followed by one treatment per week for an additional five weeks

Ketamine Infusion Therapy

Ketamine infusion therapy involves administering a single infusion or a series of infusions in a standardized medical setting. This form of administration is typically related to higher costs and lower accessibility due to labor and equipment costs. However, with nearly 100% bioavailability, this fast-acting method allows for exact dosing measurements and is often associated with increased dissociative effects. The infusion process lasts about 40 minutes, spanning around two hours for the entire visit. Commonly, patients complete a sequence of six infusions scheduled closely over the course of two to three weeks to stimulate significant depressive symptom relief.

Oral and Sublingual Ketamine

Oral administration is taken by mouth, swallowed, and digested, whereas sublingual doses using rapid dissolve tablets (RTDs) dissolve underneath your tongue, reaching the bloodstream quicker by bypassing your digestive tract. Both methods are commonly used in Telehealth or at-home settings, making them a safe, cost-effective treatment for depression. Due to the extensive metabolism, oral ketamine has a 10–20% absorption rate, while sublingual ketamine has a bioavailability of around 30%.

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Noma’s Approach to Using Ketamine for Depression

Treatment Plan

At Noma  we've developed a comprehensive 14-week treatment plan that combines the benefits of ketamine and psychotherapy.

The treatment plan unfolds in three phases:

1. Intake, Evaluation, and Orientation: (Weeks 1-2) Once admitted to the program, you’ll collaborate with your care team, including a guide, therapist and prescriber, to design your treatment plan.
2. Guided Dosing, Medical Optimization, and Therapy Cycles: (Weeks 3-11) This phase includes several ketamine dosing sessions paired with ongoing psychotherapy.
3. Final Cycle & Relapse Prevention: (Weeks 12-14) This phase consolidates the program's gains and equips you with long-term mental health maintenance strategies.

Our Unique Program Structure

Our program design focuses on your comfort in an at-home setting, leveraging data from various clinical trials to optimize treatment effectiveness. Its time-bound nature maximizes your experience without escalating costs.

Some highlights from our program include:

• Treatment in a comfortable at-home setting.
• Session length and frequency for maximum effectiveness.
• Additional services, such as one-on-one talk therapy and medication management, are included and covered by most insurance plans.
• Involvement of highly trained and specialized providers.
• Easy-to-use sublingual ketamine in the form of a rapid dissolve tablet (RDT).

A Synergistic Long-Term Approach

Led by Master's and PhD level clinicians, the Noma program emphasizes psychotherapy, particularly cognitive-behavioral therapy (CBT), to help you identify and alter negative thought patterns and behaviors. The synergistic effect of combining ketamine and psychotherapy allows for rapid symptom improvement and brain function restoration, reinforced by therapy strategies for long-term maintenance. The immediate benefits of ketamine enable you to speed up your skill mastery and improve your long-term prognosis. In emphasizing medication as a tool, not a cure, our program encourages a more practical approach that requires cohesive effort but is more cost-effective than lifelong medication.

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Safety Measures and Considerations

Some key safety measures we enlist include effective dosing and dose management, medication optimization, and the presence of our guides during dosing sessions.

Effective Dosing

We use compounded ketamine in the form of RDTs, delivered in multiple three-week dosing cycles rather than giving a large amount of ketamine upfront.  RTDs have been found to safe while maintaining clinical benefits. Although more research on the side effects of different ketamine administration methods is needed, one study noted no long-term side effects from a single dose in TRD patients. Generally, ketamine side effects often depend on the dose. In prioritizing your safety, this approach minimizes risks and optimizes treatment outcomes.

Optimizing Conventional Psychiatric Medications

At Noma, we aim to find the best combination of ketamine and traditional psychiatric medications for each patient. Everyone reacts differently to treatments, so we use a careful, personalized approach. This helps us avoid overmedicating, which can happen in conventional care. The quick benefits of ketamine allow us to create a lighter, long-term plan for antidepressants and other psychiatric medications. Our goal is to improve outcomes using the least amount of conventional medication needed."

Roles of Guides in Treatment

Our guides are essential to your journey, starting as soon as the free consultation phase. They discuss the program with you, answer questions, assist in scheduling appointments, and provide support throughout treatment. Guides supervise the ketamine dosing sessions, help set appropriate intentions for the program, deliver guided meditations to help you relax, and remain present during ketamine treatment to monitor the dosing and your overall well-being. Afterward, they check in with you for a short debrief before your session with the therapist begins.

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Learn More

The Unique Role of Noma Guides in Ketamine-Assisted Psychotherapy

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Patient Perspectives on Ketamine Therapy

Fostering Effective Treatment Through Empowerment

Patient perspectives play a vital role in understanding the effectiveness of the treatment, shedding light on the therapy's transformative power beyond mere clinical data. The aim of the program is not just to provide relief but to help you reconnect with your best self and re-engage with activities that you have abandoned due to depression. However, while ketamine can be a highly promising and effective treatment, it is not a golden pill. It creates conditions allowing self-discovery and improvement but is not a standalone solution. The program encourages you to perceive yourself not as broken or unchanging but as an individual capable of evolution and betterment.

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"For me personally, I felt there was no way out of the hole I was in. The Noma program showed me it's possible to dig myself out." - E.B. (Noma Therapy Patient)

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A Pathway for Long-lasting Change

Ketamine presents a promising alternative for the treatment of depression. Unlike traditional antidepressants, ketamine operates on a different mechanism, promoting neural plasticity and lighting up new pathways in the brain. Equally, it has a rapid effect, offering immediate relief for those suffering from depression. The potential of ketamine as a treatment for depression amplifies when combined with psychotherapy and conventional medication management. This combination fosters skill-building and long-lasting changes, helping you achieve substantial improvements in your mental health and significantly reduce the burden of depression.

Ready to Take Action Against Depression?

Schedule a free 15-minute consultation to learn more about our program, a 14-week journey that combines ketamine treatment with psychotherapy designed for long-term improvement in depression.