Treating Depression with Ketamine: A Podcast with Dr. Jennifer Jones

Depression affects 16 million Americans and is a leading cause of disability worldwide. While treatments, including selective serotonin reuptake inhibitors, such as Prozac, help many, it is estimated that at least 30 percent of people don’t respond to such medications. In this episode of Advance with MUSC Health, Jennifer Jones, M.D., details how Centerspace, a transformational center at MUSC Health, is offering ketamine, a common anesthetic, as a novel treatment to help people with difficult-to-treat mental health conditions, such as treatment resistant depression.

“Something that I hear (patients say) a lot is that before ketamine treatments, people feel like they just don't enjoy day-to-day life. Nothing in life brings them happiness, even the things that they used to do. And after these treatments, it's like ketamine can reset the brain and put the pause (button) on that part of your mind that worries always about the future or is ruminating on things that have happened in the past and helps people to be in those day-to-day moments.”
Jennifer Jones, M.D.

Topics covered in this show:

• Centerspace opened in 2020, the center uses FDA-approved and other evidence-based treatments to guide individuals through an intentional and unique journey that uses non-traditional approaches to arrive at the best version of themselves.
• They offer ketamine, a cutting-edge treatment, has been shown to be an effective medication in difficult-to-treat conditions including: depression, anxiety, trauma/PTSD, addictions and chronic pain syndrome.
• Ketamine has been approved as an anesthesia agent since the 1970s. It has been used in battlefields and pediatric emergency rooms frequently because it's very safe and does not decrease the breathing drive, unlike a lot of the different opiate types of medications that are used for pain.
• At Centerspace there are two types of Ketamine treatments. One is given as an intramuscular injection and the other is the FDA-approved nasal spray SPRAVATO®, which is often covered by insurance.
• The Ketamine therapies are given in the clinic under supervision of the Centerspace medical team. The treatment takes about two hours and requires the patient to have a ride home after.
• Jones usually tells patients to anticipate an initial series of four to six treatments.
• Unlike most antidepressants, which Jones says usually take four to six weeks to be effective, the effects of ketamine are sometimes felt within a day.
• Jones says ketamine has been life-changing for many patients who never found relief from other prescription antidepressants.
• She details a success story of a woman who was plagued by feelings of guilt and chronic anxiety with no relief from antidepressants. After ketamine treatments she now feels content and happy and is able to enjoy being with her family.
• Jones says there is also evidence that ketamine is helping people overcome substance abuse problems.

More about Centerspace:

Location: 270 Coleman Boulevard Mount Pleasant, SC 29464
Phone: 843-876-1193
Fill out an intake form

Transcript

Erin Spain [00:00:04] Welcome to Advance with MUSC Health. I'm your host Erin Spain. This show's mission is to help you find ways to preserve and optimize your health and get the care you need to live well. Depression affects 16 million Americans and is a leading cause of disability worldwide, while treatments including drugs like Prozac helped many, it's estimated that at least 30 percent of people don't respond to such medication. Here at MUSC Health, there's a place to help those with treatment, resistant depression and other difficult to treat conditions that impact health. It's called Centerspace, a treatment center that offers novel options to help people get well. Such treatments include the use of the drug ketamine. Dr. Jennifer Jones joins me to talk about center space and ketamine therapies. She's a board certified psychiatrist at Centerspace and a clinical researcher at MUSC Health. Welcome to the show, Dr. Jones.

Jennifer Jones [00:01:02] Thanks so much. And it's my pleasure to be here today.

Erin Spain [00:01:05] Well, I want to talk about Centerspace. This is a very unique center here at MUSC Health. So just tell me about the Centerspace. What is it?

Jennifer Jones [00:01:13] The idea for Centerspace was developed at MUSC in 2019 and I've been privileged to be a part of it since the very beginning. Our goal here is to help people that have really been struggling despite trying a lot of different treatment options for mental health disorders. So principally we work with folks that have treatment resistant depression, but oftentimes depression goes hand-in-hand with other conditions, whether that's chronic pain, post-traumatic stress disorder, anxiety is very common as well. But going hand-in-hand with depression and many people that come to work when I have worked with a variety of treatment providers, whether that's therapy or counseling or many different types of medications, and despite engaging in the best of care that they're still really struggling with, these symptoms are new treatment center here at Centerspace was designed to provide novel treatment options for people that have really struggled.

Erin Spain [00:02:02] Tell me a little bit about the struggle. How is depression or these other conditions impacting their daily lives?

Jennifer Jones [00:02:09] So depression and all of the mental health disorders, but depression, as an example, looks really different for different people. For some people, being severely depressed means that they can't get out of bed, that they're in bed all day except for maybe five minutes to walk their dog or to make dinner for somebody or to drop their kids off at school. Not everyone is in bed. That has severe depression all day long. We work with a lot of people as well that still go to work and are able to go through their day to day lives, but do suffer with a number of symptoms of depression. So feeling down and feeling sad, that's actually just one of many symptoms of depression, problems with concentration, trouble sleeping, decreased or increased appetite, feeling irritable or agitated. All of these different things can go into depression. Maybe that feels like a greater sense of hopelessness or pessimism about the future. We also know that these symptoms have gone up for many people over the last year and really have never gone back to the normal levels. So, you know, what the average patient looks like can vary a lot. But the unifying feature is that these are people that are looking for a new way forward.

Erin Spain [00:03:28] So what is your intention when you meet a new patient? How do you approach their journey with you?

Jennifer Jones [00:03:34] Each person, again, is an individual and Centerspace, all of us, at the clinic have research backgrounds and we have studied the science and the research trials extensively. So we know what the evidence says are the best approaches to these various mental health conditions, whether that's treatment resistant depression, post-traumatic stress disorder, anxiety disorders, chronic pain. All of these different things have some subtle nuances in what the evidence suggests. But what I want to do when I'm meeting with a patient for the very first time is to find out their story. So what have they tried before? What has worked for them? What hasn't worked for them? What are their goals for treatment? So just because someone walks in and says, I have treatment resistant depression or I have anxiety and depression does not mean that that person is going to have the same set of goals for themselves as the next person that walks in the door. And it's not my job to stipulate what their goals need to be. So I really meet with each person to find out what their concerns are about treatment and what they're hoping to see improve in their life. And then we have the honest conversation of how do we get there? Is this the best approach for them? One of the great things about being at an academic medical center as opposed to being out in the community is that we're also very well networked. So we're going to have the honest dialog about these ketamine based treatments. And there are several that we offer here at the clinic. But if someone isn't a good candidate or would be a better candidate, maybe for a different type of treatment approach, we're able to make those referrals at MUSC and elsewhere.

Erin Spain [00:05:13] So you mentioned ketamine. Let's talk about ketamine. Explain the history of this dtrug and the two types of treatments offered at Centerspace, it's really an exciting development that you're able to offer these treatments.

Jennifer Jones [00:05:26] Yeah, we're also excited to be able to bring these to light for everyone because they do offer a really new and effective treatment option for people that have struggled and despite doing many different types of treatments, sometimes really still had significant symptoms. So ketamine is not a new medication at all. It's been around an FDA approved since 1970. It was actually used in as a battlefield anesthesia agent. It's very, very safe. It's also used in pediatric emergency rooms frequently because it's very safe and does not decrease the breathing drive, unlike a lot of the different opiate types of medications that are used for pain. And it was used mostly in a surgical context or for anesthesia for nearly 30 years. In the early 2000s, though, it started being studied much more for depression and other mental health disorders. And it was found that unlike most antidepressants, which usually take at least a few weeks at more like four to six weeks to really kick in, the effects of ketamine are sometimes felt within a day. So that was a really exciting development, especially for people that were feeling profoundly hopeless or feeling like they couldn't go on.

Erin Spain [00:06:40] Every individual is different, but with the ketamine treatments that are offered, explain to me how you choose which treatment might be right for them and the core benefits of the treatments.

Jennifer Jones [00:06:49] So ketamine in its original form can be given by a variety of different methods. It's often given in the community by IV administration. So you're hooked up to an IV and it's delivered over the course of an hour. Most people don't love the idea of getting injections or being hooked up to an IV. We at our clinic mostly use injections into the shoulder, which we can customize very equivalently to the IV infusions, but without having to hook somebody up to an IV. And there's other logistical issues that go along with that. It can be given orally, but at somewhat higher risk of nausea. So we occasionally will use that, but typically using the intramuscular injection. More recently, however, there has been a subtype of ketamine called s-ketamine that was developed by Janssen. This took over a decade of research and much of our clinical team actually worked on those trials over the last 10 to 15 years, leading to its FDA approval for treatment-resistant depression and depression that was associated with thoughts of suicide in 2019. So these are both really terrific options. There are a variety of reasons that someone might be a better candidate for one type of treatment than another type of treatment. But at the end of the day, they're both really, really good new treatment options and can work much, much more quickly than folks, current antidepressants or other antidepressants that they might have tried in the past.

Erin Spain [00:08:15] And this FDA approved drug, you take it through your nose. It's a nasal spray, correct?

Jennifer Jones [00:08:20] Yeah. So it's given a little bit differently as a nasal spray. But people overall find that that that is really easy. It's something that's still done in the clinic. So this is not something that we send folks home with. And that's really for safety and monitoring. There really aren't a lot of risks to ketamine. The biggest risk is a slight increase in blood pressure, which is pretty equivalent to heavy exercise. So and that that's for a couple of hours. So for a couple of hours, we monitor someone's blood pressure. We make sure that they're doing well with the treatment. Occasionally people will have some mild nausea or some mild anxiety. And if that's the case, we have medications available to treat that because no one wants to feel queasy. For the most part, these treatments are extraordinarily well tolerated, work much, much more quickly than other medications that people have sometimes tried in the past.

Erin Spain [00:09:09] So you've had many people come in and receive these treatments. Tell me about that.

Jennifer Jones [00:09:14] We've been open officially since 2020, but logistically really more since the beginning of 2021. And since then we've worked with people. You know, one of the common themes that comes out are these are people that are looking to move forward in their lives and usually looking to see symptoms of depression improve.

Erin Spain [00:09:32] Let's talk about how many sessions and what the treatment schedule is like. And is there sort of a maintenance plan after a while? What does it all look like?

Jennifer Jones [00:09:41] Yeah, again, you know, you can take what the scientific data says about what the optimal number is. And there's a lot of variation in that. And then also, you know, looking at an individual's goals and where they're at. So there really isn't one fixed treatment approach. It also varies a little bit based on whether or not someone is looking to use the nasal spray product. It's FDA approved and very often covered well by insurance or the older style of ketamine that we typically give injections, the intramuscular shots. So we usually tell people to anticipate an initial series of four to six treatments just to see if this is helpful for them, so if they're going to turn the corner with their depression symptoms, we'll usually know by then. And if we're not, we're very objective at our clinic, we work with individuals and do a number of different assessments and questionnaires just to make sure that we are doing something that's helping someone move forward in their life. And if that's not the case, then we do network out to other treatment approaches at MUSC. Beyond that, what does maintenance look like? So that's a great question and a difficult one to answer at the end of the day. And that's largely because for some people their depression is profound. Maybe they've had depression all of their adult life in some of our patients' cases and they don't know what it feels like to not be depressed. And for them, when they go through these ketamine based treatments, the transformation can be so profound that they're terrified of going back to that depressed state. And in those cases, we work really closely with someone to figure out how do we space out the treatments. That's usually our approach. Rather than just taking a break from treatment or doing the initial series and seeing how they do, we'll usually start staggering the treatments to make sure that we're maintaining that response and that it's durable for them and that it's often part of a holistic wellness approach, too. So for many people, depression comes in the context of needing to make different life changes. And the ketamine based therapies can be incredibly helpful in helping people make those kinds of insights and also have the ability to make changes in their behaviors. Because let's face it, making new habits is not easy for anybody. Yeah, but ketamine facilitates that ability for someone to make those kind of new habits, whether that's someone interacting with their significant others or their families. Maybe it's making changes at work. We've had a number of people that have come in with depression and then realized that they're just not in a good situation in one aspect of their life or another, and then been able to use those insights to make more lasting changes.

Erin Spain [00:12:32] Now, you mentioned the ketamine has been around a long time. Some people may even recognize it as being a street drug. There's a question out there, especially with the opioid crisis, could this be addictive? It sounds like you have this in a very well controlled and n o one goes home with the medication. But just tell me about the concerns out there that folks may be having if this something that could be addictive.

Jennifer Jones [00:12:54] So the opiate crisis is near and dear to my heart. I am actually first and foremost a clinical researcher that looks for new treatment options for opiate addiction. So the short answer is, am I worried about ketamine and its addictive potential? And the answer is no to that. And that comes from a variety of different reasons. One, in the last 20 plus years of doing clinical work, we have no reported instances in the literature of someone that has used ketamine in a medical context for mental health reasons and then gone on to recreationally start using the so so developing an addiction to this. And that's part of why we are so firm in our belief that we should be using this therapeutically in the clinical sense as opposed to letting folks go home with this is a treatment where it's a much less controlled environment. The more interesting thing, though, to note about ketamine is that it's actually been studied in over 10 trials now looking at the treatment of addictions. And it looks really promising not just for depression and PTSD, but also for a variety of different substance use disorders. So sometimes those disorders are even more stigmatized than depression, unfortunately. And we'll have someone that'll come in and they'll have treatment resistant depression, not really talking about their alcohol use or other substance use. But that comes out, you know, several sessions in the day before they had come in have been having trouble controlling how much they were drinking, controlling how much they were using marijuana or opiates or other substances. And they're reporting that they're having an easier time not drinking, not using those substances. So, of course, that's something we monitor. Then as that becomes more of a goal to them, we're working with them to help them and trying to optimize the treatment approaches to reach those goals as well. Yes. You know, it's been looked at for alcohol, cocaine, marijuana, opiates and all of those different research trials it's looking helpful for.

Erin Spain [00:14:50] Are there some people you mentioned that might not be a good match for this treatment? Who would those people be?

Jennifer Jones [00:14:55] So there are a handful of disorders that we are very cautious about recommending ketamine for. So as I mentioned before, the most significant of that is uncontrolled high blood pressure. So these are people that even moderate exercise. This would probably that would be unsafe for them, people that have a history or current aneurysms, so whether that's brain aneurysms or aneurysms in other parts of the body, that can sometimes also be unsafe for people that have had recent heart attacks that might be unsafe for them. But again, if you're able to, at your doctor's discretion, safely exercise, that is probably not an issue with regard to ketamine. There are a couple of other conditions, as you might expect, that make this a relative contraindication so people that have difficulty understanding what reality is. And so this is really the different types of mental health conditions, such as schizophrenia and related types of disorders that people can sort of not have a good sense of what reality is. Ketamine can make people feel different in their mind. And if they're already predisposed to not knowing what's really real, that can make that problem even worse. So those are the two biggest contraindications. Occasionally we have people with really, really significant anxiety. And when they come in, it's not a hard stop with the ketamine, but we're also a little more cautious with our treatment approach. And that's important for us to know ahead of time to make sure that we're optimizing these treatments.

Erin Spain [00:16:29] And you mentioned that during the treatment you may feel differently. You do ask that there's someone there to drive you home as well. That's part of the process.

Jennifer Jones [00:16:38] Absolutely. So that's a hard requirement, that after the treatments, which are all done in our clinic and usually take about two hours, that someone is able to secure a ride home. But we've worked with people and a lot of different capacities. So some people have family and friends that have the ability and inclination to be able to take them to and from clinic. And when that's the case, that's great. But we've also had over half of the people that come to clinic, I would say, will take an Uber or Lyft or a taxi. So we're really pretty flexible as long as we've even had one person walk home because they lived really close by. So as long as someone is not driving themselves home, we can make things work.

Erin Spain [00:17:19] So let's talk about some success stories specifically from the clinic. Tell me just a few success stories that may resonate with our listeners.

Jennifer Jones [00:17:28] Gosh, there's so many different stories because each person that comes in is unique. But, you know, a few that have really touched my heart. We had one that was a professional woman in her mid 40s. She came in with, you know, reporting symptoms of depression. She tried a number of different antidepressants in the past. She was really plagued by strong feelings of guilt and feeling like she was never good enough. She is a very high functioning woman in a professional job and she has a family. And to the outside world, it looked like she was doing everything right. But inside she just she felt like she was never good enough. And she was plagued by that chronic day to day anxiety, like generalized anxiety and worrying about things and could never release that that tension, that stress. And she had a lot of trouble sleeping. So she came in not really expecting ketamine to do much, but feeling like it was at least one more thing that she could try. And her result, she's just had the most remarkable transformation. It's been so amazing to watch. She says that for the first time in her life, she doesn't feel depressed anymore, that she knows what it's feel like to feel content and happy and to enjoy being with her family. Like when she's with them, she's just able to enjoy being with them. And that's something that I hear a lot, is that before ketamine treatments, people feel like they just don't enjoy day to day life like nothing in life brings them happiness, even the things that they used to do. And after these treatments, it's like ketamine can reset the brain and put the pause on that part of your mind that worries always about the future or is ruminating on things that have happened in the past and helps people to be and that that day to day moment,

Erin Spain [00:19:21] That must be very rewarding for you?

Jennifer Jones [00:19:24] It is absolutely. Every day I do come to work and I love getting to see these sorts of transformations and they happen so fast. We sometimes talk about how it's almost like, you know, we're a surgeon and depression, if it was a disease, we can almost cut it out. Obviously, for some folks, it does take a few sessions. It's not every person that will see improvement with their depression or their other mental health disorders. But really, our results are very strong for the majority of people. And in the handful of cases, the minority that are not seeing as robust a response, we're really well positioned at an academic medical center here at MUSC to be able to refer to other new treatment options.

Erin Spain [00:20:05] Do people need a referral to come to Centerspace?

Jennifer Jones [00:20:08] No. Someone that has symptoms of depression or any of these mental health disorders that we've been talking about does not necessarily need to be working with someone in the community. Or to be referred from a physician or another mental health provider. If they want to find out if this would be a good treatment option, we are happy to meet with them directly. And they can do that by calling our main number that's on the site. If they are working with someone already in the community, though, we don't intend to replace who it is that they're working with currently. Our goal is instead to collaborate. And this is just, you know, one more treatment option and one more tool in the toolbox for someone.

Erin Spain [00:20:45] We will be sure to put on the website your location and ours and how people can get in touch to schedule or learn more. Before we leave today, I want to ask you a question that I asked all of our guests. What do you do to optimize your health and live?

Jennifer Jones [00:20:59] Well, the essence of what it means to stay well is to be connected to people. I'm married and I have a very supportive husband. And part of maintaining wellness is maintaining that relationship and making sure that each day I'm spending quality time with him, doing things that we love to do. We have two dogs. We love to go hiking. I also have two horses. A big part of my wellness is making sure that I'm out there riding and taking care of them, you know, as many times a week as I can. And if I don't do that, then I am not well, but I am a cranky sort of a person and have more trouble. So and I also love, love my sleep. I believe that that's a critical part of wellness. It's not a part of sleep hygiene, but I believe a good nap goes a long way too.

Erin Spain [00:21:46] Amen to that. I agree. Thank you so much, Dr. Jennifer Jones, for joining me today and talking about this remarkable treatment. And I hope that you hear from some of our listeners who may be struggling.

Jennifer Jones [00:21:56] Wonderful. Thanks again. And I appreciate the opportunity today.

Erin Spain [00:22:01] Thanks for listening. Remember to read and review us on Apple podcasts and subscribe wherever you listen to your shows so you never miss an episode. To learn more about this episode, head to advance.muschealth.org.