Experts have long been searching for a drug that can quickly provide sustained and safe relief for people who suffer from depression.
Who would have thought the answer would come in a controversial party drug?
Ketamine, which is also known as the recreational drug “Special K”, is an anesthetic that was developed in the early 1960s. It is one of the most widely used drugs in modern medicine, and is on the World Health Organization’s List of Essential Medicines. In the US, ketamine is classified as a Drug Enforcement Administration (DEA) Schedule III drug, which means it is believed to have moderate to low potential for physical and psychological dependence.
Using ketamine to treat depression is not a new idea; in the late 1990s, Yale researchers at the Connecticut Mental Health Center observed that ketamine helped depressed patients feel better.
Unexpectedly, a single dose of ketamine produced a rapid, robust antidepressant response in several patients. It started as early as a few hours after the drug was given and lasted for days, or even weeks.
Today, the findings of the world’s first randomized control trial on ketamine’s efficacy and safety as a treatment for depression in the elderly were published.
The study’s results provide preliminary evidence suggesting ketamine is effective as an antidepressant when delivered in repeated intravenous doses, according to a press release.
Led by a team of researchers from UNSW Sydney and Black Dog Institute, the trial tested different doses of ketamine amongst 16 older age participants (aged over 60 years) who had treatment-resistant depression, administered at Wesley Hospital.
“These findings take us a big step forward as we begin to fully understand the potential and limitations of ketamine’s antidepressant qualities,” said lead author UNSW Professor Colleen Loo, who is based at Black Dog Institute.
“Not only was ketamine well-tolerated by participants, with none experiencing severe or problematic side effects, but giving the treatment by a simple subcutaneous injection (a small injection under the skin) was also shown to be an acceptable method for administering the drug in a safe and effective way.”
Participants received increasing doses of ketamine over a period of five weeks, with doses optimized for each individual participant using a new dose-titration approach developed by Professor Loo’s Sydney research team and collaborators. The patients were carefully monitored for two hours after each injection.
“What we noticed was that ketamine worked incredibly quickly and incredibly effectively. After a single injection of ketamine they could be completely well in a day,” Loo said.
Loo explained what the study participants experienced to ABC:
“Some people think, ‘oh maybe it was just a drug induced temporary high’ — and it wasn’t.
You had the woozy effects in the first hour or so, but the antidepressant effects kicked in later.
When we asked people about all the facets of depression it wasn’t like we thought they were better because of this one thing — like it made you sleep better, or it made you eat better.
All the symptoms of depression across the board disappeared.
So they felt better, they were able to enjoy things, they were interested in life, they were able to eat better, they had lots more energy — the whole lot happened at once.”
Little is known about ketamine’s potential side effects at different doses, which include cognitive and dissociative effects, elevated blood pressure and heart rate, liver inflammation, and urinary problems, Loo explained:
“These results are a promising early piece of the puzzle, but the risks of ketamine use are still not wholly understood. Future studies with greater sample sizes are needed to formally assess ketamine’s side effects, such as its impact on liver function.”
Loo and her colleagues are in the process of conducting a much larger, three-year trial into the drug’s effectiveness as a treatment for major depression.
The findings of this pilot study are encouraging, Loo added, but more research is needed, reports ABC:
There are now two critical thresholds to be passed before ketamine can be considered a proven treatment for depression.
“We need to have these kinds of results in larger numbers of people, and that’s the study we’re currently doing,” Professor Loo said.
“The second one is, if it’s only one treatment the effects tend to wear off after a few days — you need to give multiple treatments.
“The effectiveness and the safety of giving multiple treatments needs to be examined in further studies, and that’s what we’re also doing in our current study.”
Even though the drug has not been officially approved for depression, off-label prescribing is legal. In a recent interview with NPR, Dr. Sanacora of Yale – who has treated hundreds of severely depressed patients with low doses of ketamine – said doctors ask him if he’s concerned about possible long-term risks:
Sanacora has a simple answer.
“If you have patients that are likely to seriously injure themselves or kill themselves within a short period of time, and they’ve tried the standard treatments, how do you not offer this treatment?” he says.
More and more doctors seem to agree: A survey of providers in the U.S. and Canada showed that “well over 3,000” patients have been treated so far, Sanacora says.
Several small studies have shown that ketamine does something no other drug can – it often relieves even suicidal depression in a matter of hours.
Psychiatrists at Yale have conducted several controlled trials for ketamine use in adolescents, specifically in those who are at high risk for suicide and are not responding to other treatments. Dr. Michael Bloch is one of the child psychiatrists who are using this treatment to help young and vulnerable patients. In a recent interview with Scientific American, he explained that while caution is necessary, research so far is promising:
“Suicide is the second leading cause of death in adolescents. 40% of depressed adolescents don’t respond to first-line treatments. Another half of those don’t respond to multiple trials of medication paired with psychotherapy. Other than electroconvulsive therapy, which carries its own risk of memory problems, doctors have almost no other choice.”
When used in a medical setting, ketamine is considered safe. It is the only anesthetic that does not suppress the body’s cardiovascular and respiratory systems. However, it does have the potential to elevate heart rate and blood pressure, so the patient’s vitals must be monitored during treatment.
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Contributed by Lily Dane of The Daily Sheeple.
Lily Dane is a staff writer for The Daily Sheeple. Her goal is to help people to “Wake the Flock Up!”