Depression is a feeling that humans have grappled with for centuries. The earliest accounts of what historians have interpreted as reports of depression show people believed depression was a spiritual condition rather than a biological health disorder. It was thought in many cultures across the world that depression and other mental illnesses were brought on by demonic possession.
The Greeks and Romans began to look at depression differently. They theorized that depression was biological in nature. There were even some doctors who classified it as a psychological disorder. These physicians were the early psychotherapists that came up with the first medications and therapeutic treatments for depression.
While many of the therapies eased stress, few treatments have proven to be highly effective at treating the biological factors of depression between the time of Hippocrates and today. Without a doubt, two of the biggest innovations in the treatment of depression in recent years are selective serotonin reuptake inhibitors (SSRIs) and at-home ketamine therapy.
Selective serotonin reuptake inhibitors (SSRIs) have become the most commonly used antidepressants. At-home ketamine treatments are the latest discovery that promises to change the way depression is addressed and provides another option for people who haven’t seen results with SSRIs.
Both hold great promise in treating depression, but is one better than the other? Are there any similarities, or are they completely different types of treatment for depression?
This review compares the two depression treatments so that patients have a better understanding of why one may work while the other doesn’t.
How SSRIs Work
Selective serotonin reuptake inhibitors are regularly prescribed for moderate to severe depression. Prozac and Zoloft are probably the best known selective serotonin reuptake inhibitors.
SSRIs are designed to increase serotonin in the brain by blocking it from being absorbed by nerve cells (reuptake). Serotonin is a neurotransmitter that sends signals between nerve cells in the brain. With more serotonin in the brain, messages are sent between nerve cells more easily and clearly.
SSRIs do this without heavily impacting other types of neurotransmitters. Studies have shown that over time SSRIs can help build and strengthen neural connections (neurogenesis), which means it leverages neuroplasticity to some degree. Neuroplasticity refers to the brain’s ability to change and reorganize in response to experiences and learning by forming new neural connections. SSRIs do this slowly over the course of months, but neurogenesis appears to be limited.
All SSRIs work in the same way but they do so at different levels. Some SSRIs are more potent than others at inhibiting serotonin reuptake. Different SSRIs are also metabolized at different rates, which can affect efficacy and side effects.
How At-Home Ketamine Therapy Works
At-home ketamine treatments are almost as simple to take as SSRIs, but they work in a very different way. Ketamine is a different classification of medication. It’s what’s known as a psychedelic. Psychedelics have chemical compounds that bring on psychodynamic meditative or transcendental changes within the conscious state of mind.
Researchers now know psychedelics like ketamine bring on this transformative mental state because it activates neuroplasticity. Ketamine treatments significantly bolster neurogenesis in a rapid fashion by affecting different brain chemicals.
Medical experts are still examining how ketamine affects the brain to create such a powerful neurogenesis response, but a few things are known. When ketamine enters the brain it binds to NMDA receptors. When this occurs it prompts the production of a neurotransmitter called glutamate. The surge in glutamate activates AMPA receptors that regulate fast synaptic transmissions in the brain. These AMPA receptors are required for activity-dependent neuroplasticity that increases synaptic strength.
Activation of AMPA receptor connections trigger the production of molecules that build new neural pathways. It’s a process called synaptogenesis, and it’s the basis of neuroplasticity. Put simply, ketamine helps the brain build new neural connections and improve communication between neurons in a very efficient way. This has a profound effect on alleviating depression.
Although ketamine got a bad wrap as a recreational drug, the scientific evidence of its ability to support neuroplasticity and produce therapeutic benefits is extremely strong. As such, the FDA approved ketamine as treatment for depression in 2019.
Effectiveness of SSRIs
Antidepressants are effective 40-60% of the time. That means roughly half of people who take SSRIs still struggle with depression despite taking the antidepressant. There are also a few downsides to this treatment option:
- It takes SSRIs 4-12 weeks to take effect.
- Different combinations of antidepressants may have to be tried to find the right dosage or combination.
- Over 50% of people experience side effects that tend to subside after the first few weeks. The most common side effects for SSRIs are diarrhea, headache, nausea and sleep problems.
- Roughly 10% of people stop taking SSRIs because of side effects.
- SSRIs have been shown to increase suicide attempts among teens and young adults under 25 years old.
One reason SSRIs are sometimes ineffective is because the brain chemicals that are being targeted aren’t balanced by the antidepressant. It’s not uncommon for a person to go through several combinations of antidepressants before finding the right mix of medications.
Unfortunately, there is a lack of studies that examine the use of SSRIs and other antidepressants over the long-term. Most studies only do follow up for 12 weeks to measure effectiveness. There isn’t enough data to determine if antidepressants like SSRIs remain effective or have risks if taken for extended periods.
One recent study did examine people who had taken SSRIs and other antidepressants for two years. The research compared these individuals to others who had also been diagnosed with depression but didn’t take any medication. The researchers found the group who took antidepressants didn’t have a higher quality of life compared to the medication-free group. Followup studies are needed to address a few key points, but this study suggests that over the long run SSRIs and other antidepressants don’t have much of an impact.
The solution as some medical experts see it is to find a supplemental treatment or another form of therapy altogether.
RELATED READ: How Do You Know Antidepressants Aren’t Working?
Effectiveness of At-Home Ketamine Treatments
Just as psychedelic research suggested in the 1950s, ketamine has been found to be highly effective at treating depression among a number of other mental health disorders. But that’s not what has excited the mental health community the most.
A significant difference between SSRIs and ketamine is that ketamine is a treatment option for those who haven’t responded to SSRIs. Research has shown at-home ketamine therapy is effective in cases of treatment-resistant depression. If SSRIs or serotonin-norepinephrine reuptake inhibitors haven’t eased symptoms there’s still a good chance ketamine treatments will.
Another key difference is how quickly ketamine treatments begin resolving depression symptoms. Unlike SSRIs, ketamine is fast-acting and patients can feel the effects in just hours.
Because of this, the use of ketamines for depression is extremely promising for those with severe depression that are already having suicidal thoughts.
In terms of response rate, one study found that 64% of patients respond positively after a single dose of ketamine. Another study suggests that less than half of patients taking IV ketamine treatment experienced side effects. When side effects were experienced they usually subsided within an hour.
Want to Know More About At-Home Ketamine Treatments for Depression?
Millions of people struggle with depression every day, but they don’t have to struggle anymore. Even if antidepressants haven’t worked at-home ketamine therapy is still an option. Find out if ketamine therapy is the solution you’ve been searching for - take our free online assessment.