Ketamine Treatment Shows It’s Effectiveness with Treatment-Resistant Adolescent Depression
For generations, teenagers have struggled with depression, and treatment has been only moderately effective. We need to treat adolescent depression urgently. Failed grades, lost schooling due to poor attendance, interrupted social development, broken dreams…
Pressures of Achievements
A young woman who had excelled in high school, was senior class president, a drum major for the marching band, and had great SATs wanted to be an ophthalmologist and headed out of state for college.
Hard-working and self-disciplined, she held a job to help pay her expenses, got involved in campus politics, and began trying her hand at a few new freedoms. A little under age drinking led to a lot more, and the pressures of college and work eventually pushed her to consider suicide. Before long she was diagnosed with major depressive disorder and suicidal ideation.
Her doctor prescribed medications for her depression, but nothing changed. Time passed without improvement.
She had to take a leave of absence from school. Just getting out of bed and going to class had become insurmountable.
But ketamine can treat adolescent depression.
Coping Mechanisms That Isolate Teens
A young man had “wowed” his way through grade school and junior high. He’d been invited to a magnet school focused on science and technology for his high school years. After winning a pile of awards for his debate team, as well as in math and science competitions, he couldn’t continue.
The agoraphobia and social anxiety that plagued him in restaurants and barber shops finally conquered his courage. He refused to go in to get haircut ever again. It was just too crippling…too stifling. So his hair grew and grew until it reached his waist over the ensuing years. He always wore a long dark tweed coat his grandfather had given him. He felt safer inside that coat.
But he drew attention, too. When he walked into a pharmacy security personnel shadowed him until he left…assuming he carried weaponry under that coat. But he wasn’t a threat. He was suffering from major depression and phobias and coping the best he knew how.
He’d tried a variety of medicines his doctor prescribed, but he continued to get worse. It colored his outlook about everything.
Depression in Teens: About More Than Attitude
Adolescent depression is a serious illness that interrupts a young person’s normal social, mental, and academic development. It colors the way he or she sees the world, and the people in it.
In adolescents, the prefrontal cortex is not yet fully developed, due to their age. This portion of the brain makes judgments, considers consequences and outcomes, controls impulses and emotions, and helps people understand each other.
So without this development already in place, a teen is more likely to make dangerous decisions on the spur of the moment, overlook the cost of his actions, and react to people and situations without a balanced understanding of the results.
When you add depression to this mix, and the impaired outlook that goes with it, a teen with untreated depression can cost himself and others failed goals, injury, and painful consequences.
For these reasons, depressed adolescents need treatment options that work. And ketamine is a remarkable option to treat adolescent depression.
When Treatment Fails, Better Options are Paramount
As many as 40% of depressed teens are not helped by the first round of treatment, and only half respond to the second round. We’ve talked before about how failed treatment affects teens with bipolar disorder, and how each successive attempt at treatment lowers the likelihood of a therapeutic response with traditional medications.
But the same is true with major depression in teens.
Studies demonstrate that these young developing brains need protection from the ravages of severe disorders to avoid serious consequences.
Effective treatment for adolescent depression that restores the brain to healthy function is vital.
Because of the critical cost of untreated disorders, researchers have delved into the quest for novel and potent treatments that do restore a teen’s brain to normal function. That bring remission. (And remember, we consider a disorder “untreated” even when current treatment isn’t working.)
Since ketamine in small doses has been receiving such recognition for its effectiveness with children and adults in treatment of depression, anxiety, bipolar disorder, PTSD, OCD, and suicidal thinking, some researchers surmised it should be effective with teens, too.
In Search of Effective Treatment
In a study published this month in the Journal of Child and Adolescent Psychopharmacology, a research team led by Kathryn Cullen, MD set out to gather more information about the use of ketamine to treat depression in adolescents. And they made some important points upon completion of the study.
They provided 6 ketamine infusions spread over 2 weeks to 13 adolescents who suffered from treatment-resistant depression. Initially, they based dosage on the ideal body weight for the participant’s age. None of the participants responded to the first infusion, so they changed their strategy. Dosing was then based on actual body weight … and guess what?
Obese participants received doses according to their body weight and experienced a solid response with the higher dose.
This demonstrates the importance of personalizing the dose to achieve remission.
Another important point is that prior studies indicated that pediatric patients require a higher dose than adults to achieve a dissociative state, which is an important aspect of ketamine treatment.
The same seemed to hold true with these adolescents, which may indicate that adolescents respond to ketamine treatment more like children than adults.
Understanding that key point can help psychiatrists in personalizing dosing for adolescents they treat.
Cullen’s research team concluded that ketamine treatment may be a significant option for relieving treatment-resistant depression in adolescents. And that psychiatrists need more research to determine ideal dosing for this age group.
Just to make an observation … and let you in on a secret. In the world of neuroscience, researchers make exceptionally cautious statements about their findings. They may sound a bit underwhelmed. But they aren’t. When a researcher says that a treatment may be effective for a given population, it’s akin to your neighbor setting off 30 minutes of fireworks!
Here at Innovative Psychiatry we treat adolescents regularly who suffer from treatment-resistant depression, and watch them emerge from ketamine treatment with joy, restored resilience, energy to be creative, motivation to achieve, and enjoyment of their relationships.
If your teenager suffers from major depressive disorder, and traditional treatments haven’t helped, call us.
The sooner your child is treated, and his brain development is restored to its best function, the more he or she can continue to grow into the healthy and resilient adult he or she is meant to be.
To the restoration of your best self,
Lori Calabrese, MD