How Can Esketamine Help Treat Treatment-Resistant Depression?

The iconic motivational speaker and author Denis Waitley once said, “As long as we are persistent in our pursuit of our deepest destiny, we will continue to grow. We cannot choose the day or time when we will fully bloom. It happens in its own time.” This persistence is also an essential component of recovery. Even when we feel as though nothing is working (as can happen with treatment-resistant depression), we must forge ahead and continue to try new things until something works. With the right attitude, motivation, perseverance, and partners, there will be a solution.

What Does It Mean to Heal at the Cellular Level?

Healing at the cellular level is all about healing as an interconnected enterprise. This means that we must heal the physically, mentally, emotionally, and spiritually. If one of these aspects goes untreated, then the other three will, ultimately, also fail to fully heal.

Healing at the cellular level is also about getting to the root/core causes of our problems. Many treatment centers’ recovery plans only go “skin-deep.” They remain surface-level recovery plans. Often, this is because they don’t have an individualized recovery program. Rather, they use preset treatment plans.

At Exclusive Hawaii Rehab, we have found that overarching “one-size-fits-all” recovery plans rarely work. They don’t incorporate the person along with the diagnosis. This misses all those crucial details such as family history, occupation or career, and recovery goals. Now, this is why a “multi-angled” approach to recovery can be so beneficial.

The Importance of a Multi-Angled Recovery Approach

A multi-angled recovery approach is all about utilizing as many means, methods, and modalities as needed to best serve us in our quest for recovery. This is especially true with treatment-resistant depression. It also means that we must be ready and able to draw from all areas of treatment and recovery.

These areas include “traditional” mental health psychotherapies like cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT), experiential therapies like nature immersion therapy and surf therapy, and holistic options like acupuncture, meditation, and yoga. Of course, when it comes to treatment-resistant depression, many of these methods may fall flat. This is why esketamine and ketamine-assisted psychotherapy can be so beneficial in opening an individual up to what these treatment options have to offer.

Better Understanding Treatment-Resistant Depression

Treatment-resistant depression is very much what its moniker sounds like. It is a type of depression that traditional treatment modalities tend not to work on. Of course, there is more nuance than just being a persistent depression.

According to the peer-reviewed journal Neuropsychiatric Disease and Treatment, “Treatment-resistant depression (TRD) is a subset of Major Depressive Disorder which does not respond to traditional and first-line therapeutic options. There are several definitions and staging models of TRD and a consensus for each has not yet been established. However, in common for each model is the inadequate response to at least 2 trials of antidepressant pharmacotherapy.” The question then becomes how do we know if depression is treatment-resistant?

One key is to be aware of the signs and symptoms of treatment-resistant depression. The other key is to speak up when those signs and symptoms become apparent.

The Signs and Symptoms of Treatment-Resistant Depression

We often forget that it is okay to speak up when a certain treatment or recovery method is not working. We become hesitant because we feel that the doctors and professionals know more than we do. The fact is that when it comes to the science of recovery, they most likely do. But, when it comes to our mind and body and how we feel, they will only know if we are open and honest with them.

We must learn to advocate for ourselves when something is not working. Addiction and mental health recovery is not an exact science, and it is common to make adjustments to a treatment plan. Also, speaking up is the only way that the people helping us are going to know if we are dealing with treatment-resistant depression. 

However, before we speak up, it is crucial that we be able to spot the warning signs of treatment-resistant depression. The following are just a few of those warning signs and symptoms:

• Typical depressive symptoms such as lethargy and anxiety become more severe
• The depressive episodes start to last longer
• There is a reduced ability to partake in and experience pleasure (also known as “anhedonia”)
• The number of depressive episodes continues to increase
• Wanting to isolate away from friends and family more and more
• Medications bring little to no relief
• Therapy brings little to no relief
• Feelings of self-harm and suicidal ideations keep popping up
• Attempting self-harm and suicide

As we can see, these symptoms can be very severe. This is why continuing to seek a solution is imperative. Giving up is not an option for treatment-resistant depression. One solution that is showing more and more promise is the use of esketamine and ketamine-assisted psychotherapy.

What Exactly Is Esketamine?

Esketamine is a variation (or derivative) of ketamine that has been shown to help people struggling with treatment-resistant depression. It has also become more accepted among the professional addiction specialist community and government agencies.

According to the clinical journal Epidemiology and Psychiatric Sciences, “In March 2019, the US Food and Drug Administration (FDA) approved a nasal spray formulation of esketamine for the treatment of resistant depression in adults. Esketamine is the S-enantiomer of ketamine, an FDA-approved anesthetic, known to cause dissociation and, occasionally, hallucinations. While ketamine has not been approved for depression in the USA or any other country, it has been used off-label in cases of severe depression.” This severe depression includes that of treatment-resistant depression.

Essentially, esketamine is the tool that is used in ketamine-assisted psychotherapy. It is not the therapy itself. Many people are under the misconception that ketamine-assisted psychotherapy is somehow a less regulated type of treatment. This is not the case at all. It is not just about utilizing esketamine for recovery; it is about utilizing it alongside specialists who also have a professional background in psychotherapy.

What Exactly Is Ketamine-Assisted Psychotherapy?

Ketamine-assisted psychotherapy is the utilization of esketamine to help individuals recover from issues of addiction and/or mental illness. Specifically, it has shown a lot of promise regarding treatment-resistant depression.

According to the Journal of Pain Research, “From available [ketamine-assisted psychotherapy] KAP publications, it is apparent that combined treatments can, in specific circumstances, initiate and prolong clinically significant reductions in pain, anxiety, and depressive symptoms, while encouraging rapport and treatment engagement, and promoting abstinence in patients addicted to other substances. Despite much variance in how KAP is applied (route of ketamine administration, ketamine dosage/frequency, psychotherapy modality, overall treatment length), these findings suggest psychotherapy, provided before, during, and following ketamine sessions, can maximize and prolong benefits.” Also, these are not the only benefits of ketamine-assisted psychotherapy for treatment-resistant depression.

Utilizing Ketamine-Assisted Psychotherapy for Treatment-Resistant Depression

The benefits of esketamine and ketamine-assisted psychotherapy are vast and varied. The following are just a few of those benefits:

• Relives the feelings of being overly “stressed out” or anxious
• Reduces the need/want to isolate
• Helps reduce the cravings for alcohol or substances (often a way to self-medicate for treatment-resistant depression)
• Helps reduce the intensity of depressive episodes
• Can help reduce the frequency of depressive episodes
• Brings back feelings of joy and excitement for activities once enjoyed
• Can reduce feelings of physical pain often brought on by depression
• Reduces the need/want to self-harm
• Helps to reduce suicidal ideations
• Opens up pathways to once-blocked creativity
• Can open up the ability for other means, methods, and modalities of recovery to work.

Other Means, Methods, and Modalities to Help With Treatment-Resistant Depression

It is important to understand that just because it is labeled “treatment-resistant depression,” this does not mean that all treatments should be disregarded. This is especially true while utilizing ketamine-assisted psychotherapy because this modality can often change other treatments’ efficacy potential.

Then, there are certain aspects of recovery that just logically make sense. For example, it only makes sense that good nutrition is going to correlate to a better opportunity for recovery. When our bodies are healthy, it creates an essential foundation upon which to build the healing process.

Treatment-Resistant Depression and Nutritional Therapy

Here at Exclusive Hawaii Rehab, we believe in the maxim; “Food is medicine.” This is because we have found that nutrients and nutrient replenishment of vitamins, minerals, and antioxidants are essential for healing at the cellular level. Also, our focus on nutrition and nutritional therapy is not just about what is being taken in but also about what is being left out.

According to the Journal for Nurse Practitioners, “Nutritional Therapy uses food to prevent and reverse diseases that plague most western societies: diabetes, obesity, heart disease, arthritis, and depression. In order for food to be therapeutic, it must be nutrient-dense, measured in part by the nutrients and anti-nutrients, contained in consumed foods.” Also, “In order for foods to be therapeutically beneficial, the appropriate micro and macronutrients must be delivered in a nutritionally dense format without contaminants.” This nutrient “density” is crucial here at Exclusive Hawaii Rehab.

However, we don’t just focus on the nutrition aspect of food. We also focus on the pleasure and satiation that food can (and must) bring. This is why all of our meals are prepared by world-class chefs and tailored to each client’s individual needs. No, food is not a “be-all cure” for depression, but it is certainly linked to mood and well-being. Another tool that is linked to well-being is interacting with nature.

Treatment-Resistant Depression and Nature Immersion Therapy

A very basic aspect of interacting with nature is the potential to get essential vitamin D from being out in the sunshine. According to the peer-reviewed journal Issues in Mental Health Nursing, “Depression in its own right is a disabling condition impairing all aspects of human function. In persons with a chronic medical disease, depression often makes the management of chronic illness more difficult. Recently, vitamin D has been reported in the scientific and lay press as an important factor that may have significant health benefits in the prevention and the treatment of many chronic illnesses.” Also, getting vitamin D is not the only benefit of engaging with nature.

The variety of benefits of engaging with nature often surprises people. According to the International Journal of Environmental Research and Public Health, “Besides improvements to physical and psychological well-being, exposure to natural environments has been shown to bring about positive impacts on cognitive functioning.” Also, “While cognitive restoration and physiological well-being are the prominent and renowned benefits of nature exposure, there is one important construct that is often overlooked in environmental psychology research studies – that is, the human-nature relationship; also known as connectedness to nature (CN).”

Connecting with nature is a way to reconnect with ourselves. This is often an essential component that is missing in those struggling with treatment-resistant depression. Another type of nature immersion therapy that can help with this connection is surf therapy. 

Treatment-Resistant Depression and Surf Therapy

Many people who participate in ketamine-assisted psychotherapy find that they are much more willing to try activities they would have otherwise rather avoided. On Hawaii’s Big Island, one of these exceptional activities is surf therapy.

Surf therapy has been found to have many benefits beyond reducing feelings of depression. According to the 2022 International Journal of Environmental Research and Public Health, “Carefully planned water activities tailored to the needs of the individual can contribute to correct psychosocial and cognitive development. The International Surf Therapy Organization summarizes the benefits of adequately indicated surf therapy as follows: improved physical health and mobility; improved mental health, including reduction of specific symptoms, such as posttraumatic stress and depression; improved well-being (strengthening of trust and confidence, encouragement of independence, resilience and protective coping strategies) and improved social skills.”

Many other types of physical activities have been shown to be helpful in people struggling with depression. One of the most prominent is yoga.

Treatment-Resistant Depression and Yoga

Yoga has been practiced for over 3,000 years as a means of attaining spiritual enlightenment. Of course, yoga has transitioned into other areas of life in recent years. One of the most exciting new areas that yoga has ventured into is mental health and addiction recovery.

Now, yoga is not an outright “cure” for treatment-resistant depression. However, it has been shown to have many benefits that may certainly be helpful. According to the International Journal of Yoga (IJOY), “Therapeutic yoga is defined as the application of yoga postures and practice to the treatment of health conditions. Yoga therapy involves instruction in yogic practices and teachings to prevent reduce or alleviate structural, physiological, emotional, and spiritual pain, suffering, or limitations. Yogic practices enhance muscular strength and body flexibility, promote and improve respiratory and cardiovascular function, promote recovery from and treatment of addiction, reduce stress, anxiety, depression, and chronic pain, improve sleep patterns, and enhance overall well-being and quality of life.”

Yoga can also be a great supplement to ketamine-assisted psychotherapy because it also focuses on opening up the mind to new pathways of thought and creativity. As with the other modalities mentioned, yoga and ketamine-assisted psychotherapy can ultimately be a win-win. At the very least, it certainly poses no additional risks to exacerbating depressive symptoms. Essentially, it is all “upside.”

Healing at the Cellular Level With Exclusive Hawaii Rehab

The iconic Scottish philosopher Thomas Carlyle said, “Permanence, perseverance, and persistence in spite of all obstacles, discouragements, and impossibilities: It is this that in all things distinguishes the strong soul from the weak.” It is persistence that will ultimately win the day over treatment-resistant depression, which is why we are always focused on forward momentum here at Exclusive Hawaii Rehab.

Recovery is about the journey, never the destination. Being persistent in that journey is how we will truly prevail.

Many people may be unfamiliar with esketamine and ketamine-assisted psychotherapy. Esketamine and ketamine-assisted psychotherapy can be particularly helpful in treating treatment-resistant depression (among other addiction and mental health issues). If you feel like you or a loved one is struggling with issues of addiction, mental illness, or co-occurring disorders, we can help get you on the right road to long-term recovery right away. This is our primary purpose of healing at Exclusive Hawaii Rehab. For more information about what the ketamine-assisted psychotherapy process looks like, what treatment-resistant depression is, and how ketamine-assisted psychotherapy can help to heal at the cellular level, please reach out to Exclusive Hawaii Rehab today at (808) 775-0200.