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The new way to treat depression, anxiety and chronic neuropathic pain
Newsletter No 12 (28th April 2022)
Ketamine, MDD and Circadian activity - how response is linked to sleep patterns
A fascinating article in the Handbook of Experimental Pharmacology examines how glutamate regulates circadian rhythms, and how a favourable response to ketamine infusion in individuals with MDD might be predicted by pre-existing sleep disturbances.
At KCSA clinics, we note variability in the effect of ketamine on sleep and wakefulness from patient to patient, and this piece sheds light on the why's and wherefores. In contrast to those with MDD who respond to sleep deprivation (SD) therapy, when only 5-10% remain euthymic after recovery sleep, most ketamine-responders do not relapse following the night's sleep after an infusion.
"Recent research has identified both sleep homeostatic (sleep slow waves) and circadian components that both modulate and mediate the antidepressant and anti-suicidal effects of ketamine."
Social Anxiety Disorder (SAD) responds well to ketamine infusion...
A review and meta-analysis of several RCT's of ketamine in the treatment of refractory anxiety disorders, found that it performed best for Social Anxiety Disorder (SAD).
While ketamine as a treatment for depression has enjoyed the spotlight, the role of ketamine in treating resistant anxiety disorders has often been understated.
Glutamate regulates the stress response and plays a key role in fear extinction.
A review published in Therapeutic Advances in Psychopharmacology last year sheds light on ketamine's role in TR-anxiety disorders.
KCSA offers outpatient ketamine infusions at the following locations:
BEDFORDVIEW (GP)
CONSTANTIA (WC)
UMHLANGA (KZN)
HILTON (KZN)
Time spent on social media and watching television. particularly involving 'upward social comparison', is linked to development of depression in adolescence.
Based of a study of 3826- adolescents, a JAMA Pediatrics investigation highlights why parents should be warned.
In Newsletter #2 the tragedy of teen suicide and the 'ketamine safety-net' are discussed. We also link to a testimonial from the mother of a suicidal 14-year-old treated at a KCSA clinic.
Screen-time, depression and suicidality in adolescence...
There is a worrying upward trend in child and teenage suicide rates. In the US, between 2010 and 2020 the rate increased by 50% in 13-18-year-olds, and more than doubled in the 10-12-year-old group. A Medscape Review highlights the causative effect of social media and television.
The COVID-19 pandemic has dramatically accelerated rates of depressive symptoms among children and adolescents.
Tinnitus affects the mental health of up to 64% of sufferers - can ketamine infusion help?
The short answer is 'yes' in about 50% of cases. Interestingly, not only by alleviating the associated depression and anxiety so prevalent in tinnitus-sufferers, but because the NMDA receptor plays a key role in the pathophysiology of tinnitus in the cochlea, limbic system and cerebellum. Published in Otolaryngol Head Neck Surg 2020, a review of nearly 10 000-tinnitus sufferers found that 33% were depressed.
The failure of the Auris Trial is considered by some a failure of the delivery mechanism (esketamine gel injection into the middle ear). There is ample justification to offer a trial of ketamine infusion to patients battling tinnitus and depression.
Addressing glutamatergic circuitry by infusion to alleviate tinnitus in an animal model, was shown to provide a sustained benefit, according to an SIUSM study.
In the next newsletter..
Hot off the press... Increase in thalamic cerebral blood flow is associated with antidepressant Using Arterial Spin Labelling (ASL) to measure thalamic cerebral blood flow (CBF), researchers in Germany have linked their findings to improvement in depressive symptoms after ketamine. The fact that changes in CBF are |
How did KCSA start in South Africa?
Ketamine Clinics of South Africa (KCSA) was founded by Dr Alan Howard, a Consultant in Emergency Medicine who returned home permanently to his native South Africa from Ireland in 2019. To read more about Dr Howard and KCSA's flagship clinic in the Natal Midlands in two informative articles published in South African Psychiatry click on the link below. |
