Let’s think of the brain as a complex network of creeks and rivers. When there is a drought all the river beds turn to dry ground, the creeks become parched and dusty, and the foliage that once existed begins dying off.
Much like water running through a creek bed, our Central Nervous System (CNS) needs glutamate (the primary fuel source of the brain) to run through our nerves and properly energize the brain. Glutamate, the primary excitatory neurotransmitter in the brain, can be exceptionally difficult to control. Mood disorders, in part, are the result of our CNS not being able to fully regulate glutamate.
We have receptors in our CNS that function like a spillway in a river system. When the water reaches the level of the spillway it causes the spillway to activate and siphon away any excess water from the system. In this manner, the N-Methyl-D-Aspartate (NMDA) receptor in our CNS is responsible for keeping water (glutamate) under a steady state of control. Sometimes, even though the spillway remains functional, the system can get clogged up or develop an obstruction. These obstructions can lead to chaos until somethings is done to correct it.
Ketamine is a medication that works in a handful of ways to help reopen the system. The most well-known way it works is by blocking the NMDA-receptor or “blocking the spillway.” By blocking the spillway it causes an increase in the amount of glutamate / water held in the system. This allows for the water level to rise in a “controlled” fashion to put pressure on the obstructed tributaries to help force them back open. There are many other drugs that can do this, but Ketamine has the added benefit of unclogging the proverbial river system of our CNS. By potentiating the AMPA receptor, Ketamine helps reinvigorate lost tributaries to restore their function and flow. More specifically, the AMPA receptor promotes neurogenesis (the formation of new nerve cells), neuroplasticity (the re-alignment of neurons / learning), and has modulatory effects on inflammation in the CNS.
In a persistent mood disorder, the AMPA receptor is like a dead car battery. The battery needs a good jump to restart. Some batteries will jump start easily, while some are much more resistant and require a much longer and greater charge. However, when the AMPA receptor has enough glutamate to work properly, it performs as it was designed to do, which is build new neurons, help neurons communicate effectively, and decrease inflammation.
People affected with mood disorders often feel significantly better after receiving ketamine infusions. The healing occurs, in part, by correcting damage in the CNS caused by an incompetent NMDA receptor and poor regulation of glutamate.
Ketamine does not appear to be a cure for chronic disorders. Whatever caused the problem in the first place may still exist. Therefore, you need to continue seeing your mental health professional, so they can work with you to address your long-term needs. Ketamine infusions can be a bridge leading to a rapid decrease in symptoms. Since the brain is a miraculous, complex organism, it takes careful maintenance for those “rivers” to keep running at the proper levels with healthy fuel for your brain. Once Ketamine has kick started the healing process in the CNS you may require periodic maintenance infusions to maintain your quality of life. Only you know when you need an infusion. We are here to help you as you continue your journey of healing.
This is an oversimplified explanation of one of the mechanisms by which mood disorders occur. This analogy is not meant to fully explain the complexity of mood disorders. It is meant to highlight the fact that mood disorders frequently become treatment resistant, in part, due to poor regulation of very important neurotransmitters, like glutamate.