In Brazil, people with resistant depression use ketamine; how does she act? – 06/10/2022

Among those diagnosed with depression, there are those who suffer from a type that is difficult to treat: resistant depression. In it, the patient usually does two different types of treatments correctly and does not improve.

Physiotherapist Cláudio Andrade de Oliveira, 46, for example, was diagnosed with it during the pandemic. He was already taking two medications in the morning and one in the evening. But when covid-19 spread around the world, his condition worsened and the doctor made the diagnosis.

Cláudio has suffered from mental disorders since adolescence. At 18 he was already taking anxiolytics and he even had severe depression when he lived in the United States in 2004, at which time he could not afford private treatment.

In 2009, he returned to Brazil and returned to treatment, but in the pandemic his mental health worsened: he just lay down and could no longer work. “The psychiatrist increased the medication as much as possible and sometimes changed it, but nothing resolved, I continued with extreme depression”, he reports.

Cláudio has suffered from depression since adolescence - Personal archive - Personal archive

Claudio has suffered from depression since adolescence.

Image: Personal archive

Things only started to improve in January of this year, after he tried a treatment with ketamine, which is working. “Until today I didn’t feel that extreme anguish and anxiety anymore, I feel the normal everyday worries that everyone has”, she says.

Today, he continues to be monitored by the specialist, but was released from the treatment he had earlier this year. “Currently I was discharged, after having had six infusions with ketamine”, he says.

What is ketamine?

to cetamine is a hospital anesthetic used in several countries, including Brazil, for sedation purposes, but it is also a new alternative for the treatment of resistant depression. In Brazil, it was approved in November 2020 by Anvisa (National Health Surveillance Agency) as a medication for this type of mental disorder.

For this purpose, according to the Agency, it must be administered exclusively in a hospital or in a specialized clinic and in the presence of a health professional. Its use is being intravenously or as a nasal spray, but it is not yet available in the SUS.

Despite the results of studies carried out withetamine to be encouraging, it is necessary to be careful with the prescriptions, according to Alexander Moreira de Almeida, associate professor of psychiatry at the UFJF (Faculty of Medicine of the Federal University of Juiz de Fora) and coordinator of the PTA (Anxiety Disorders Program) from the same institution.

“It is a medication that was recently launched and that seems to have a faster onset of effect, but it is still not known about its effectiveness and safety in long-term use”, warns Almeida. “There has been a strong advertising campaign to promote this medication, but caution is needed,” he says.

When administered, the substance enters the brain, triggers a process of rewiring neurons and leaves the body in approximately 20 hours. In this way, the cells start to “talk” better with each other, with a better connection. With this, the areas affected by the disease work better again and patients notice an improvement in the symptoms of depression.

However, there are side effects. “The adverse effects of ketamine happen during the infusion and are potentially serious and even fatal, hence the need for an anesthesiologist to accompany the procedure and to be inside a hospital with full monitoring – cardioscope, oximeter and blood pressure measured every 10 minutes “, says Tiago Gil, anesthesiologist, founder of the ketamineactive member of ASKP3, American society of ketamine physicians, psychotherapists & practitionersand a volunteer researcher at the IPq-HCFMUSP (Institute of Psychiatry, Hospital das Clínicas, Faculty of Medicine, University of São Paulo).

Among the most common side effects are:

  • Increase in blood pressure;
  • Increased heart rate;
  • General anesthesia with respiratory arrest;
  • Nausea and vomiting;
  • Dissociation (an altered state of perception of the world around you).

According to the anesthesiologist, all symptoms disappear within 24 hours after the infusion.

the doctor Amanda Rock*, 37, who also suffers from resistant depression, had a good response to treatment with the substance. “It’s a milestone in my life, because I’ve gotten better and I have almost no side effects, just dissociation, nausea and dizziness, but it passes quickly,” she says.

She was diagnosed about 20 years ago and initially it was mild, so she was treated with an antidepressant only. For two years she responded to the treatment, but then it stopped working.

Medication was adjusted and others were added, but the disease fluctuated. Amanda also had electroconvulsive therapy sessions, but never significantly improved. “I could never get the meds out,” she says.

However, in 2020, she also discovered ketamine, and this time, she had good results. “I did six sessions with application in the vein, but as it is a relatively new drug, not even health professionals have much knowledge and are afraid to refer the patient for this type of treatment”, says Rocha.

Today she says she is much better, but Follow doing sessions sporadically.

Resistant depression diagnosed after two failed treatment attempts - iStock - iStock

Resistant depression diagnosed after two failed treatment attempts

Image: iStock

Are there other treatments for resistant depression?

Resistant depression is presented by a patient who, even after being treated with two different classes of antidepressants, in adequate doses and duration of treatment, does not improve of the disease.

“The probability of responding to the third medication used drops a lot. This was evident in a study carried out in the United Kingdom, in which the quality of responses to the antidepressant in its first, second, third and fourth were evaluated. dose“, says Tiago Gil.

Psychiatrist Raissa de Alexandria, from the HULW-UFPB (Lauro Wanderley University Hospital of the Federal University of Paraíba), linked to the Ebserh Network, explains that resistant depression is one of the most serious conditions of the disease. “These are dragged frames that become chronic and can reach more serious symptoms, such as suicidal ideation. But this can also happen even in a non-refractory condition”, she ponders.

According to the expert, between 10% to 15% of patients who have depression end up having a depression that is refractory to treatment.

For resistant depression, in addition to conventional drugs linked to therapy, it is possible to treat the condition with transcranial magnetic stimulation, which is also used for the treatment of several other psychiatric pathologies.

Electroconvulsive therapy is another option for the pathology and, according to experts, is a very important tool that can save lives.

Psychotherapy is also important. “There are studies that show that if the patient does cognitive-behavioral psychotherapy, in addition to the use of antidepressants, he can improve”, says Alexander Moreira de Almeida.

There are also other medications, in addition to antidepressants, that can, together, enhance the treatment.

Whatever the treatment, the patient must follow the guidelines to the letter. “It is essential that the patient has an adequate adherence to treatment. Often he forgets to take the medication for a few days, does not take it regularly or uses other substances such as alcohol or drugs that can affect the functioning of the medication”, Alexandria warns. .

It’s hard to talk about healing when it comes to mental disorders. In these cases, when the treatment reaches its goals, the individual returns to a normal life, as before being affected by the disease. But that doesn’t mean that at some point he can’t have a relapse.

That is why it is important that, even after discontinuing the medication guided by the doctor, the patient practices physical activity, has social interaction and has a hobby that makes him feel good.

*At the character’s request, his name has been changed

About Jenni Smith

She's our PC girl, so anything is up to her. She is also responsible for the videos of Play Crazy Game, as well as giving a leg in the news.

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