New Hope for Treatment-Resistant Depression, PTSD or Severe Anxiety Disorder

When people do not respond as well as hoped to medicines prescribed for depression, PTSD or severe anxiety disorder, the symptoms can be debilitating. Some studies show traditional medications may fail up to 60% of afflicted patients. The patient’s quality of life may suffer greatly: at work, at home and in relationships. Sadly, many cases involve suicidal ideation. At this point, people need therapy that works rapidly and effectively. Prescribers can work with a compounding pharmacist to formulate a plan that works best for each individual patient.

Researchers have investigated why patients develop depression, post-traumatic stress disorder (PTSD), and severe anxiety disorder. Understanding the roles of different brain regions and how they connect, and how nervous system pathways can become dysfunctional led researchers to try new targeted therapies.

Studies show ketamine to be remarkably effective for these “tough to treat” conditions. Ketamine is FDA-approved as an anesthetic but when very low doses are used, physicians have reported rapid antidepressant and anti-anxiety activity with very few negative effects. Various compounded dosage forms of ketamine were used and the success rates in the studies ranged from 50-80%!

Compounding pharmacies are tasked by physicians to use their expertise to formulate ketamine into nasal sprays, flavored and palatable solutions and troches, and rapid dissolve tablets. Customization of these dosage forms allows the physician to personalize ketamine therapy for the best possible patient responses. For patients interested in these forms of administration, it is best to contact the treating physician to determine if it is appropriate for their treatment and for referral to a high-quality compounding pharmacy.

Caution: Patients should never stop current treatments such as anti-anxiety or antidepressant medications without speaking with their physicians. Although most medications are safe to use during ketamine therapy, check with your local compounding pharmacist or treating physician for more details.

By Jim Hrncir RPh; Las Colinas Pharmacy Compounding & Wellness; Irving, TX

P3 is a subsidiary of the Alliance for Pharmacy Compounding. APC is the voice for pharmacy compounding, representing compounding pharmacists and technicians in both 503A and 503B settings, as well as prescribers, educators, researchers, suppliers, and patients.
In traditional compounding, pharmacists create a customized medication, most often from pure ingredients, for an individual patient pursuant to a prescription. Pharmacists’ ability to compound medications from pure ingredients is authorized in federal law and for good reason: manufactured drugs don’t come in strengths and dosage forms that are right for everyone, and prescribers need to be able to prescribe customized medications when, in their judgment, a manufactured drug is not the best course of therapy for a human or animal patient.
Every day, APC members play a critical role in patients’ lives, preparing essential, custom medications for a range of health conditions, including autism, oncology, dermatology, ophthalmology, pediatrics, women’s health, animal health, and others.
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Ketamine and other N-methyl-D-aspartate receptor antagonists in the treatment of depression: a perspective review, Zarate, et al, Ther Advanc in Chronic Diseases May 2015.
Effect of Baseline Anxious Depression on Initial and Sustained Antidepressant Response to Ketamine, Ionescu, MD et al, J Clin Psychiatry 2014.
Diazgranados and colleagues sought to determine if ketamine produces rapid antidepressant effects in subjects with bipolar depression [Diazgranados et al. 2010].

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