Computer games designed to boost self-esteem appear to prolong the antidepressant benefits of the mind-blowing anesthetic ketamine.
A recent study of 154 people found that those who played games featuring smiley faces and positive messages remained depression-free for up to three months after a ketamine infusion, reports a team in the American Journal of Psychiatry.
People who received ketamine alone tended to relapse after a week or two.
The findings are important because “we need new approaches that help people feel better faster and feel better,” says Rebecca Price, study author and associate professor of psychiatry and psychology at the University. of Pittsburgh.
Established medications like Prozac and Zoloft can take weeks to relieve depression and don’t work for all patients. Ketamine can provide immediate relief, but the effects often wear off after a few days or weeks.
“And then coming back for infusions over and over again to maintain that relief can end up being really painful and expensive,” Price says, “and just isn’t accessible to all patients.”
How to prolong the antidepressant effect of ketamine
Price and a team of researchers therefore wanted to find a way to prolong the antidepressant effects of ketamine. They decided to focus on a common symptom of depression: low self-esteem and self-loathing.
The team relied on research suggesting that ketamine temporarily causes certain areas of the brain to enter a state in which they form many new connections. During this period, the brain seems to be more receptive to learning and change.
“So we tried to use that window of opportunity right after ketamine to strengthen associations specifically between the idea of me, myself, and positive information and attributes,” Price says.
The team asked some participants to play special computer games for 30 to 40 minutes a day for four days after receiving a ketamine infusion.
Find ways to reinforce positive connotations in the brain
In games that involved words, whenever a player saw the letter “I,” it was followed by positive terms like “good, lovable, gentle, worthy, etc.”, Price explains.
In other games, participants had to click on a photo – of themselves or of a stranger – as soon as it flashed on an area of the screen.
“Every time they click on their own photo, what appears right after in the same spot is a smiley face,” Price explains.
The games had a surprisingly powerful effect.
“By doing these very simple computer exercises, we could prolong the antidepressant effect of a ketamine infusion for at least a month,” says Price, adding that the effect can last up to three months.
If these results hold up in larger studies and for a longer period of time, the approach could make ketamine treatment much more affordable, says Dr. Sanjay Mathew, professor of psychiatry at Baylor College of Medicine and co-author of the study.
Currently, insurance rarely covers treatment, and a single ketamine infusion can cost anywhere from $300 to over $800. “That’s obviously a huge challenge for a lot of patients and the main reason why we can’t send more patients to ketamine,” says Matthew.
The cost is even higher for patients who receive a nasal version of ketamine called Spravato, which has received Food and Drug Administrationl approval for the treatment of suicidal depression and depression that has not responded to other treatments.
An automated, computerized addition to ketamine treatment would be welcome right now because mental health professionals are in short supply, Mathew says.
“It could be widely disseminated in clinics that don’t have the resources to be able to engage in a number of psychotherapies that work on self-esteem and self-beliefs,” he says.
It’s also possible that the combination approach will work for other conditions treated with ketamine, including addiction and alcohol use disorders, Mathew says.