If you are visiting this website you are most likely dealing with a major depressive disorder (MDD) that has not responded to other medication. Many of you will have had trials of all the available antidepressants. Some of you have had ECT and /or TMS with no significant improvement in your condition. Chances are that you can no longer function at home, work or school, and find even small tasks, like showering, insurmountable.
Periods of depression are common mood disorders that most people face from time to time. They follow life events and disappointments that impact us deeply. These kinds of depression are generally short lived and respond to psychotherapy, conventional drug therapy or simply tincture of time. They are not crippling. But, lifelong MDDs are something different, and are more likely associated with suicidal thoughts and attempts.
Nearly all of the patients with MDD that I treat are survivors of childhood trauma. They are actually suffering from post-traumatic stress disorder (PTSD). Childhood trauma can arise from a variety of causes; abject poverty, physical, mental or sexual abuse, neglect, parental divorce, disabilities, and bullying, to name some. All of the above result in stress, anxiety, pain and feelings of low self-worth. It is these feelings that morph into MDD, beginning as early as the late teens and continue thereafter. The cause is a change in brain chemistry brought on by childhood stress, with subsequent changes in brain anatomy that are difficult to repair.
Brain Derived Neurotropic Factor (BDNF) is an important brain chemical. It is responsible for the maturation and maintenance of the neuronal dendrites and synapses that are necessary for normal brain connectivity. That is, in order to have a normal mood, the neurons in various parts of your brain need to be able to connect to each other via their dendrites and their synaptic contact. Childhood stress and anxiety inhibit the production of BDNF, leading to visible changes in neuroanatomy and subsequent serious mood disorders such as MDD, PTSD, obsessive compulsive disorder (OCD), and anxiety.
Over the past five decades, antidepressant research and medications have revolved around the regulation of three neurotransmitters; serotonin, dopamine and norepinephrine. Together, they represent about 15% of the brain’s neurotransmitters. Much more prevalent is the neurotransmitter glutamate, which has only recently begun to receive attention as instrumental in treating mood disorders. It is via the glutamate system and two important receptors, NMDA and AMPA receptors, that ketamine works to relieve depression. It does so by turning back on BDNF production. The BDNF then leads to repair of the damaged neurons with regrowth of the important dendrites and synapses needed to achieve a normal mood. Animal models show us that the repair can begin in a matter of hours after the administration of ketamine. This process of brain repair is called neuroplasticity, and ketamine facilitated neuroplasticity offers great hope for patients with MDD who have not responded to other treatments.