When Traditional Therapies Aren’t Enough.

By Laura Freeman

Pain isn’t just experienced by the body. When suffering goes all the way to the depths of the soul, depression can be just as deadly as any other disease.

While talk therapy and traditional antidepressants work for many patients, when they don’t, particularly when there is suicidal ideation or a life that no longer works, giving up isn’t an option. That’s when it’s time to look into other possibilities that are showing results. Ketamine—yes, ketamine with the bad press from when patients try to self-medicate or celebrities overdose—is proving its value in cases of resistant depression that have failed other therapies.

“One of the things noted after using Ketamine as a sedative that doesn’t depress respiration is that a surprising number of patients reported improvement in their symptoms of depression,” double board certified anesthesiologist and pain management physician Harrison Irons, MD, said. “It’s been around since the 1960s and safely used in treating humans and in veterinary medicine to sedate small animals without having to worry about respiratory effects. During Covid it was often part of the sedation to help patients tolerate ventilators without further burdening their respiration. Around ten years ago, Ketamine came into use for resistant depression with good results.

“Working in a pain clinic, you see many patients whose suffering turned into despair. We were working with patients with PTSD and other conditions where anxiety and depression were complicating treatment and taking over their lives. I had been following the data on the effectiveness of ketamine and started offering it when other therapies failed. Depression took the lives of someone I knew and their child. Ketamine therapy as a controlled infusion hasn’t been easy for chronically depressed patients to access. Psychiatrists can prescribe it, but most aren’t set up to administer multiple infusions. So I started a clinic, Southern Ketamine And Wellness, to make the therapy available for patients still struggling after other treatments. We see patients from all over Alabama and surrounding states.”

Irons works in coordination with the patient’s psychotherapist and other physicians. Although ketamine can be injected, and a form of it is now available as an inhalant, he prefers a series of infusions that allow him to make small adjustments as the drug is being administered.

“With this protocol, we’re seeing significant improvement in around 85 percent of cases of resistant depression. We start with two infusions a week for three weeks, and we can follow up with a booster if and when needed,” he said.

Ketamine seems to modulate the brain’s glutamate receptors and promote synaptic growth and plasticity. Improvement is often quickly noticeable.

“In our practice, the infusions tend to provide better results, but we do offer the nasal medication, Spravato (esketamine) as an option since it may be covered by insurance and is available for patients who can’t come in for infusions,” Irons said. “Since treating depression with infused ketamine is still off-label, it’s a direct pay procedure, but patients are usually pleased with the results.”

Irons is also one of the few physicians in the area who treats patients with another hard to manage condition known as the suicide disease because relief is so hard to find. It can quickly leave many practitioners frustrated and ready to give up.

“CRPS, Complex Regional Pain Syndrome, is a strange and difficult condition that can start with something as simple as a stubbed toe,” he said. “The nerves get caught in a pain loop that continues to get worse. Then inflammation develops. It can spread and even migrate around the body. Just about everything we would normally do has little to no effect. We have to break the pain loop.”

Irons has used ketamine to treat CRPS and says so far the results are encouraging,

“Intervening as early as possible is important,” he said. “This syndrome can quickly get worse, spread and become even harder to resolve. Don’t underestimate how much the patient is hurting or how desperate they may become.”

Although many patients self-refer after reading about the clinic or talking with other patients, Southern Ketamine and Wellness clinic is also getting a lot of calls from physicians and psychotherapists. The clinic’s primary office is in Vestavia, and a second location is near Auburn.

It’s a new option in the patient care toolbox to help those who have given up on everything else so they don’t give up on life.