The last three years of Margie’s life have been really good.
She works at the front desk in a veterinarian’s office. She’s a happily married mother of a 17-year-old son and 15-year-old girl. She’s looking forward to sending them to college and dreams of moving south with her husband.
All of this is possible, she says, because of ketamine. Without it she wouldn’t be able to get out of bed. She couldn’t help her children achieve their goals. She wouldn’t be able to eat, sleep or take care of herself. She would be clinically depressed and having suicidal ideations.
“It’s like I’ve come back to life or something,” says Margie, who asked that we not use her last name to protect her family’s privacy.
Ketamine — a general anesthetic and alternatively used party drug — has become what some doctors are calling the latest innovative medicine in curing treatment-resistant clinical depression. This year, it’s become the focus of an $11.8 million Cleveland Clinic-led study that compares the effectiveness of ketamine to electroconvulsive therapy.
Typically used for patients who aren’t responsive to antidepressants, ECT is a psychiatric treatment that electrically induces seizures in patients and carries a near-70 percent remission rate. However, patients may prove to respond faster and more effectively by receiving ketamine intravenously.
“Hopefully we can learn what kinds of patients seem to respond best, what regimen we can use to help them respond optimally, and what impact that can have,” says Dr. Donald Malone, the Cleveland Clinic’s chairman of the Center for Behavioral Health.
In 2005, Margie was diagnosed with stage 2 breast cancer. She had a mastectomy, went through four months of chemotherapy and 6 1/2 weeks of radiation treatment. As a precautionary measure, doctors gave her a 5-year prescription for tamoxifen, an estrogen modulator that prevents cancer from reoccurring.
During the first two years, she reeled from insomnia and sudden mood swings and also started showing symptoms of depression.
“Depression is like a dark hole you can’t get out of,” says Margie. “I wouldn’t say it’s a loneliness. You just stare into space. You just want to cry all the time. You don’t want to eat, you don’t want to go back to bed. You don’t want to do anything. It was a fight for me just to get up and take care of the kids.”
The following six years, doctors prescribed antidepressants such as Zoloft, Wellbutrin and Prozac. Each one would work for a time, but after several months her symptoms would reemerge.
“About 10 percent of everybody has an episode of depression sometime in their lifetime,” says Malone. “If you realize about 20 percent of those patients who do have depression don’t respond very well to our traditional treatments, that leaves huge numbers of individuals who are suffering.”
In an effort to safely regulate Margie’s medication, she enrolled in Cleveland Clinic Lutheran Hospital’s Mood Disorder Program in 2013 and began receiving ECT treatment three times a week in 2015. But three weeks later, little had changed. Margie started experiencing memory loss as a side effect of ECT. There are six months of her life — a visit to her mother’s in Florida, trips to Cedar Point with her kids — that she still can’t remember.
As her depression grew, she took a leave of absence from work. Her mother moved in to help take care of her and her kids when she began exhibiting suicidal thoughts. She confided in close friends who checked in with her daily.
“I couldn’t come out of it,” says Margie. “It just got so bad I wanted to die.”
In December 2015, Margie started undergoing ketamine treatment. Three times a week, she’d go to Cleveland Clinic’s Lutheran Hospital to receive a 45-minute slow drip of the drug.
“It took maybe two weeks of treatments before I had any clarity,” says Margie. “I was more energetic. I wanted to do things I hadn’t been doing for quite a long time.”
She returned to work after three months. By the summer, she was becoming more active, attending Cleveland Orchestra concerts at Blossom Music Center with her husband and going to dinner with friends. Now, she’s stabilized enough to only receive ketamine infusions once every eight weeks.
“I won’t say I don’t have bad days. I do, but it’s changed my life,” says Margie. “I just had no hope for anything, and there’s hope now.”
The current trial will follow 400 treatment-resistant patients like Margie at the Cleveland Clinic, Yale University, Icahn School of Medicine at Mount Sinai in New York and Baylor College of Medicine as they undergo multiple infusions of ketamine twice a week or ECT three times a week. Over the next two years, doctors will follow-up with patients to determine short- and long-term side effects and to compare the effectiveness of each treatment.
“At some point, you have to try something different,” says Malone. “Effectiveness really is a return to being either symptom-free or dramatically less of a symptom burden.”