*The FDA has not approved intravenous ketamine or NAD+ for the treatment of any psychiatric or pain condition. These articles reference off-label use. Like all medical treatments, the discussed therapies carry risks and benefits. Speak with a doctor at Clarus Health to learn if these therapies may be right for you.

Ketamine Therapy
Jun 23, 2024

Treatment Resistant Depression Treatment: Ketamine & Stellate Ganglion Block

IV Ketamine and SGB overcome the challenges of treatment resistant depression for faster and safer symptom relief.

Treatment Resistant Depression Treatment: Ketamine & Stellate Ganglion Block

Treatment resistant depression refers to depression not being relieved using the upper dose limits of 1-3 anti-depressants. Unfortunately, by this definition, many patients will have to wait weeks or months to find relief from depression. They may also risk experiencing side effects during this waiting time. Learn how IV Ketamine and the Stellate Ganglion Block can provide an entirely different approach to improving our mental health at the root cause.

What Causes Treatment Resistant Depression?

Causes of treatment-resistant depression (Howes et al. "Treatment resistance in psychiatry: state of the art and new directions." Molecular psychiatry, 2022)

There are many factors that can contribute to treatment-resistant depression:

  1. Forgetting to take medications
  2. Inadequate absorption of medications from the intestines (sometimes due to genetic changes in P-glycoproteins in the gut endothelia or from the gut microbiome)
  3. Faster breakdown of medications, such as from smoking tobacco (inducing activity of CYP450 enzymes in the liver, especially CYP1A2)
  4. Genetic mutations that increase medication breakdown (CYP450 enzymes)
  5. Medications not crossing the blood-brain barrier, therefore not being able to reach the target site in the brain. This can be due to genetic mutations in the ABCB1 gene affecting P-glycoprotein.

This has serious consequences for patients who are faced with 2-6x higher costs compared to patients with non-resistant depression. These patients also also twice as likely to be hospitalized and require more psychiatry visits. Furthermore, quality of life is roughly 25–40% lower in patients with TRD. Lastly, 30% of patients with TRD will attempt suicide.

IV Ketamine can Overcome Treatment Resistant Depression

IV Ketamine uniquely helps overcome many of these reasons for treatment resistant depression:

  1. IV Ketamine avoids any problems with gut absorption because it bypasses the gastrointestinal tract altogether. Bioavailability of IV Ketamine is 100%.
  2. Supervised IV Ketamine can produce rapid results that can last for weeks-months with very few treatments, reducing the risk of forgetting to take medications.
  3. IV Ketamine can be delivered at personalized doses to overcome mutations in genes that breakdown ketamine. This is because the IV dose can be finely adjusted, unlike oral medications.
  4. Unlike SSRI, SNRI, and TCA medications, IV Ketamine uses an entirely different neurotransmitter to reduce depressive symptoms.

Stellate Ganglion Block for Treatment Resistant Depression Overlapping PTSD

A history of trauma is often present in patients with treatment-resistant depression. To holistically address depression, the underlying PTSD must also be addressed. Like IV Ketamine, the Stellate Ganglion Block (SGB) is a revolutionary treatment for mental health conditions, especially those influenced by the fight-flight response, like PTSD. The Stellate Ganglion Block (SGB) overcomes the traditional challenges of treatment-resistant depression in many ways:

  1. SGB does not require any medication absorption by the gastrointestinal tract and directly acts on neurons.
  2. Mutations in blood-brain barrier proteins do not affect the SGB because it is directly affecting neurons in the neck, not the brain.
  3. A single SGB can provide months of relief, removing the need to remember to take daily medications.
  4. Mutations in liver enzymes don't appear to affect the SGB because its affect is not dependent on medications acting in the brain.
  5. Unlike SSRI, SNRI, and TCA medications, SGB affects entirely different neurotransmitter to reduce PTSD symptoms.

Learn More About IV Ketamine + SGB

IV Ketamine and SGB are safe procedures when under physician supervision. Learn more from our doctors if your treatment-resistant depression or PTSD may benefit from the Stellate Ganglion Block and IV Ketamine with a consultation with Clarus Health.

Anthony Kaveh MD

Anthony Kaveh MD

Dr. Kaveh is a Stanford and Harvard-trained anesthesiologist and integrative medicine specialist. He has over 800,000 followers on social media and has guided hundreds of patients throughout transformative healing experiences. He is an authority on Ketamine, NAD, and SGB therapies. He is a registered continuing education lecturer in the Bay Area.