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    More People Are Using Ketamine For Depression – But How Safe Is It?

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    As we focus on mental health this October, it’s important to remember that of the many crises plaguing South Africa, depression is one of them. A 2022 study by Wits highlighted key findings: South Africans suffer higher rates of depression and anxiety than other countries. Only a quarter of those ever receive treatment. And, since treatments are subject to costly long-term psychologist visits or psychiatrist prescriptions, some people are turning to unconventional treatments. Among them, there’s a noted rise in people treating their symptoms with psychedelics. Now, there’s an increase in ketamine use to treat depression in cases where other medication has failed. Amazing, right? Not so much, say experts.Per experts, using ketamine for depression is a revelation (more on this below). However, the misuse as a party drug and the mounting unsupervised use as a treatment for depression is problematic.  “The anaesthetic drug can bring life-saving hope for people suffering treatment-resistant major depression or at severe risk of suicide. But unsupervised use or excessive dosages hold addictive and even lethal risks,” warned the South African Society of Psychiatrists (SASOP) in a recent press release.So… what is ketamine?Ketamine is an anaesthetic, originally used in animals since the 1960s. In humans, it’s been used to treat pain since the 1970s. It’s listed in the World Health Organization’s List of Essential Medicines as an anaesthetic. It’s also registered in South Africa for induction and maintenance of anaesthesia. If you were to break a bone, a doc might use ketamine instead of full anaesthesia.When it’s used recreationally, K produces dissociative sensations and hallucinations. Users report feeling relaxed, dream-like and nauseated. In its newest era, K is a breakthrough treatment for depression, with others claiming it works for other mental health conditions too.How does ketamine help with depression?Ketamine is available for off-label use. This means that regulations allow doctors to use it for purposes other than pain management. Studies have shown that it’s a viable treatment for depression and suicidal urges, especially in cases where other medications haven’t worked.“There is good evidence that ketamine in low doses, administered under controlled conditions with the necessary medical supervision, is an effective treatment for treatment-resistant major depression,” explains SASOP spokesperson, psychiatrist Dr Bavi Vythilingum. “It is also effective in acute cases of suicidal ideation, rapidly reducing the risk of life-threatening thoughts and acts.”How does it work? Image by Maxim Berg on Unsplash

    Per Dr Vythilingum, K improves the production and functioning of the neurotransmitter glutamate. This plays a role in mood, thought patterns and cognition.

    Ketamine has a different mechanism to traditional anti-depressant medications. And, it’s why medical researchers believe it to be at least part of the reason for its effectiveness where other treatments have failed. Unlike conventional antidepressants like SSRIs, which take weeks to work, the effects of ketamine are rapid. It also doesn’t work on the same brain receptors.READ MORE: Why Toxic Positivity Is Harmful And What To Say InsteadHow is ketamine for depression administered?To use ketamine for depression, you’re meant to head to a treatment facility. There, you’d be given a dose via I.V. It takes about 40 to 50 minutes, and there’s extra time to recover afterwards. After the treatment, you’ll need someone to take you home – no driving until after they have had a full night’s sleep. But you’re not A-OK after just one session. The initial treatment takes place in six sessions over two to three weeks. The treating psychiatrist may prescribe maintenance treatment on a case-by-case basis.The dissociative state (the trip) caused by ketamine can produce feelings of a trance-like state or hallucinogenic experience, feelings of an “out-of-body experience”, feelings of unreality, visual and sensory distortions, and euphoria or “a buzz”.“For this reason, it is important that the setting is safe, meaning that it is quiet and private, that treatment is medically supervised, that the patient is not left alone during treatment and recovery, and that the facility is equipped to manage any adverse side effects,” says Dr Vythilingum.While the dissociative side-effects can also be positive in improving depressive symptoms, she said other negative side-effects could include nausea and vomiting, raised blood pressure, respiratory depression (slowed breathing), sedation and unconsciousness.Image by Dima Pechurin on UnsplashBut… ketamine can also be lethal  While the treatment is a game-changer for many, there are significant risks. “Ketamine is a powerful anaesthetic agent. A too-high dose can cause sedation and loss of consciousness and in very high doses, may cause dangerously slow breathing and the risk of death,” explains D Vythilingum. “Even at lower doses, if administration of ketamine is not adequately supervised and the person is not in a safe, controlled setting they may become confused and inadvertently harm themselves. Ketamine is also potentially addictive and open to abuse.”Added to this is the rising number of “independent” clinics offering ketamine treatment for depression and other mental health conditions. SASOP is concerned about these facilities: whether they’re correctly diagnosing patients and using ketamine as the appropriate treatment. The treatment also has to be carefully monitored for harmful side effects.READ MORE: 4 Proudly South African Apps For Mental Health SupportKetamine’s side effects can be dangerousLong-term use of ketamine at high doses can cause bladder, kidney, liver and stomach pain or toxicity, as well as addiction demanding increasingly higher, life-threatening, doses. Plus, while some claim that ketamine is effective in treating other mental health conditions, such as post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD), SASOP cautions that there is limited scientific evidence for this.Image by Alexander Grey on UnsplashHow to stay safe in treatmentIf you choose to pursue ketamine for depression, it’s totally legal. Just make sure you’ve picked a facility that dots its i’s and crosses its t’s.Find specialists“Ketamine for psychiatric treatment must be prescribed by a psychiatrist. Only a psychiatrist can diagnose that depression is treatment-resistant,” explains Dr Vythilingum. “That diagnosis is made following at least two courses of conventional antidepressant medication with no improvement in symptoms.” She also made clear that only a doctor can administer the meds “and both physical and psychological safety are paramount during administration of ketamine.” SASOP advises that the guidelines issued by the South African Society of Anaesthesiologists (SASP) should be adhered to. These guidelines state that the medical doctor administering ketamine must be an anaesthesiologist or registered sedation practitioner who is qualified in advanced cardiac life support and resuscitation.Check the facility  “Ketamine must be administered in a facility equipped for physiological monitoring (blood pressure, pulse rate, oxygen saturation), with medication, equipment and qualified personnel to manage adverse physical or neurological events, including hypertension, cardio-respiratory events, airway management and resuscitation.“The administering clinician or member of the team should also have expertise in mental health and managing patients who may become agitated, anxious or otherwise distressed. A psychiatrist should be available in case of a psychiatric emergency,” Dr Vythilingum said.READ MORE: These 3 Mental Exercises Can Help You Find Your Purpose In Life At Any AgeIt’s not for everyoneKetamine is not considered safe for patients diagnosed with schizophrenia or for those with a history of substance abuse. Dr Vythilingum also cautioned that while there is clear evidence for the off-label use of ketamine in treatment-resistant major depression, more research was needed on the drug’s long-term effects, side effects and safety as a psychiatric treatment.Equip your mind with these reads More

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      Many Women Are Battling Depression During Pregnancy. Here’s What To Know, If You’re Struggling

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      In South Africa, between 21 and 47% of women experience depression during pregnancy. The global average? 12%. This means South African women are at higher risk during a crucial period of their lives. Depression during pregnancy can also often continue well into childbirth and beyond. “Pregnancy-related depression is often dismissed as ‘just the baby blues’ and women are told to ‘just pull yourself together’, but it is a serious mental health condition which not only negatively affects women’s quality of life and experience of motherhood, but the prospects of the next generation too,” says Doctor Bavi Vythilingum, a member of the South African Society of Psychiatrists.

      Why does depression during pregnancy happen?

      Dr Bavi says this is down to a number of factors. For one, pregnancy is an inherently life-altering event that can be stressful, and hormones might play a role. For another, the rates of intimate partner violence in South Africa are high and could lead to depression.

      In South Africa, violence against women worsens when a woman is pregnant. Substance abuse during pregnancy can also be a driver of depression. “The use of alcohol and substances puts the woman at risk of depression and also creates a vicious cycle where depression makes somebody use substances more, putting both the mother and the child at risk,” says Dr Bavi.

      There are also genetic factors. “If your mother had depression, you are more likely to get depression,” explains Dr Bavi. And then there are cases where women might have been depressed in earlier pregnancies (or, who get depressed during their menstrual cycle), which increases the risk of depression in any subsequent pregnancies.

      READ MORE: Want To Manifest Your Goal? Don’t Make These Manifesting Mistakes

      The risks of depression during pregnancy

      “Depression during pregnancy can have an effect on the unborn child,” says Dr Bavi. “It’s associated with an increased risk for things like preterm labour, for small gestational age babies (when the baby doesn’t grow properly) and for pregnancy-induced hypertension.”

      If depression continues after childbirth, this affects mother-child bonding, growth and development of the infant.

      READ MORE: 7 Ways To Meditate For Anxiety Relief That Are *Actually* Easy To Do

      Signs of depression

      Generally, a low mood that’s prolonged can be a sign of depression. Also, changes in appetite, sleeping too much or too little, wanting to self-harm, lack of motivation and lack of interest in things that used to be interesting are also warning signs.

      READ MORE: How To Support A Loved One If You Think They Are Suicidal

      What to do, if you think you’re depressed

      The first line of defence would be psychotherapy, says Dr Bavi. “Many women don’t get better on psychotherapy or can’t access psychotherapy,” she notes. If this is the case, medication in the form of SSRIs can be taken. They’re safe for use during pregnancy and won’t pose a risk to the baby, Dr Bavi says.

      Depression during pregnancy is a serious issue and poses risks to both the mother and the child. If you suspect you’re struggling, get help by contacting a psychologist or psychiatrist.

      The South African Depression and Anxiety Group (SADAG) lists toll-free helplines for general depression and anxiety, and has free support groups around the country for various issues, including support for expectant and new mothers. Call 0800 21 22 23 for help and information.

      In addition, you can join the network mumsupport.co.za for a caring community of women supporting women. More