Ketamine and Transcranial Magnetic Stimulation: Providing New FDA-Approved Mental Health Treatments

Nearly 60 years have passed since chemists first noticed that a monoamine-based tuberculosis drug appeared to lift symptoms of depression. That discovery, which led to one of the first drugs to treat depression, touched off a cascade of similar medications that modulate neurotransmitters, significantly improving outcomes for countless patients. Today, the latest approaches offer patients more hope than ever before.

New Treatments for Depression and PTSD

The latest FDA-approved treatments target the complex nature of mood, anxiety and trauma-related disorders. These new approaches deliver welcome relief for the up to 30.9% of patients with depression[1] and up to 50% of patients with PTSD who don’t respond to traditional medications.[2] When combined with comprehensive, evidence-based psychotherapy, these innovative treatments help clinicians develop individualized paths to recovery.

“We use what works,” says Robert McFerren, LICSW (he/him/his), executive director at ERC Pathlight. “We’re always looking into new modalities.”

Innovations at Work

Eating Recovery Center and Pathlight Mood & Anxiety Center (ERC Pathlight) is constantly working to incorporate new medications and modalities into treatment plans.

1. Ketamine

Ketamine is one of the latest treatments ERC Pathlight has adopted. In 2019, the FDA approved this nasal spray for use in patients with treatment-resistant depression (TRD).

Within hours of administration, ketamine can provide symptom relief that lasts up to a week, though responses vary.[3]Albert Tsai, MD (he/him/his), psychiatrist at ERC Pathlight, explains that most ERC Pathlight patients start ketamine treatment with a score of at least 30, indicating severe depression on the Beck Depression Inventory. After an average of six to eight doses, the score dips into the teens. “We’re making an impact in treating severe depression and trauma, which is so difficult to break through,” says Dr. Tsai.

With traditional antidepressants, patients can struggle for weeks or months waiting for new medication to take effect and hoping it will help. Ketamine fast-tracks symptom relief enough to make other treatment modalities, such as cognitive behavioral therapy, more effective.

Ketamine is administered as a medical procedure in controlled dosages (0.5–1 mg for each kilogram of patient weight). Patients remain in the clinic for two hours of observation, during which a nurse monitors blood pressure and for side effects. Treatments are typically given twice per week. While ketamine’s mechanisms of action haven’t been fully explained, research has shown that, as an antagonist, the drug readily binds to NMDA receptors, changing the electrical activity of neurons. The current theory is that the resulting glutamate surge leads to the stimulation of specific neurons and restoration of neuronal connections that were lost due to stress, both of which result in antidepressant effects.[4] The new neuronal wiring promotes neuroplasticity, allowing flexible and adaptive thinking.

Read: The Role of the Psych Nurse in Ketamine Treatment

2. Transcranial Magnetic Stimulation (TMS)

Another innovative treatment offered by ERC Pathlight physicians is transcranial magnetic stimulation (TMS). In this treatment, “a medical device alters electrical activity by applying magnetic fields to the brain regions involved with emotion regulation and cognitive processing,” explains Melissa Mott, MD, PhD (she/her/hers), psychiatrist at ERC Pathlight.

The FDA approved TMS to treat five days a week for five to six weeks. During the procedure, patients feel a scalp sensation and hear a tapping sound. A 2018 study showed that, combined with psychotherapy, TMS decreased Beck Depression Inventory scores by at least half in 66% of 196 patients with TRD, 109 of whom (56%) achieved remission.[5]

3. Virtual Care

It is not widely known that ERC Pathlight was the first treatment provider to offer virtual intensive outpatient programming (IOP) back in 2016. With more than 7,000 patients treated virtually since then, our research shows that a program rooted in best clinical practices and evidence-based treatments, led by clinical experts, delivers exceptional patient experiences and outcomes. Data show statistically significant and clinically meaningful improvements in pathology symptoms, higher completion and attendance rates than on-site IOP, strong connections to peers, and proven effectiveness in treating children and adolescents.

Emerging FDA-Approved Treatments

As an organization, ERC Pathlight prioritizes the careful integration of emerging FDA-approved treatments. “People are suffering out there,” says Dr. Tsai. “We really want to be on top of FDA-approved treatments and embrace the explosion of new evidence-based approaches.”

McFerren agrees. “The bottom line,” he says, “is that ERC Pathlight providers are inspired by the sentiment that we have a huge responsibility to provide the best service that we can to benefit patients and make their lives better.”

Free Consultations for Ketamine, TMS & Virtual Care

Please contact us to make a referral or schedule a free consultation with a master’s-level clinician at 1-877-825-8584.

The Tools to Rebuild Life After Trauma

Gloria (she/her/hers), Pathlight alumnus, lives a full life in a Midwest suburb working as a software engineer, volunteering at a local animal shelter and traveling the world. But before she had access to innovative evidence-based treatments at Pathlight, Gloria found herself coping with suicidal thoughts from untreated trauma.

At the age of 12, Gloria was in a car accident that killed her father instantly and left her in a coma with significant injuries. Her family did the best they could, but she was left to pick up the pieces. Overwhelmed with the slew of responsibilities, “I did what I needed to get through,” she says, “like a robot going through the motions.”

Despite devoting herself to school and other pursuits, the trauma, depression and anxiety eventually caught up to her in college when she first experienced suicidal thoughts. Psychotherapy and medications didn’t seem to keep them at bay. That’s when her therapist recommended Pathlight.

Finding Validation

Gloria found trauma group therapy particularly validating because it was her first time being surrounded by others who also had firsthand experiences with trauma. Her therapist gave her tools to manage “overthinking” and challenge upsetting thoughts by reframing them.

Gloria explains that, through Pathlight’s resources and safe environment, she built up a foundation of tools for lifelong management of her PTSD, depression and anxiety. “For the first time,” says Gloria, “I finally found people who understand me.”

Citations

1. Zhdanava, M., Pilon, D., Ghelerter, I., Chow, W., Joshi, K., Lefebvre, P., & Sheehan, J.J. (2021). The prevalence and national burden of treatment-resistant depression and major depressive disorder in the United States. Journal of Clinical Psychiatry, 82(2), 20m13699

2. Institute of Medicine. (2014). Treatment for posttraumatic stress disorder in military and veteran populations: Final assessment. Washington, DC: The National Academies Press

3. Zanos P, et al. (2016). NMDAR inhibition-independent antidepressant actions of ketamine metabolites. Nature, 533(7604), 481-486

4. Duman, R.S., & Aghajanian, G.K. (2012). Synaptic dysfunction in depression: Potential therapeutic targets. Science, 338(6103), 68-72

5. Donse L, et al. (2018). Simultaneous rTMS and psychotherapy in major depressive disorder: Clinical outcomes and predictors from a large naturalistic study. Brain Stimulation, 11(2), 337-345