Monday, February 5, 2007

Ketamine lifts depression quickly

Tackling depression with ketamine NewScientist 1/20/07 (subsription) ""FOR MANY, it was a huge, obvious effect," says psychiatrist John Krystal. "One of the patients said, 'Don't give me those old medications, I want this again'." Krystal, a professor at Yale University, is talking about the time he gave seven severely depressed patients ketamine, a mind-blowing drug developed as an anaesthetic but better known as a club drug. It was a long shot, but the results were astonishing. Though most of the patients found the ketamine experience itself unpleasant, once it wore off they had a far better feeling: the disabling and suicidal depression they had lived with for years had vanished. Krystal's pioneering experiment happened in the late 1990s, but now researchers at the US National Institute of Mental Health (NIMH) in Bethesda, Maryland, have repeated the study and the results have got psychiatrists, neuroscientists and drug companies buzzing. An antidepressant that acts in hours rather than weeks would transform the treatment of depression, make a lot of money and change the way we understand the disease...It's not just depression. Other studies suggest that ketamine might act with similar speed to help addiction, post-traumatic stress disorder (PTSD) and certain chronic pain conditions. Ketamine, researchers increasingly believe, may be a "reset button" for brains stuck in dysfunctional ruts...Zarate's results were not quite as dramatic as Krystal's but were impressive nevertheless. His team recruited 17 people who on average had failed to get relief from six different drugs; four had even tried ECT, the treatment of last resort. Of the 17, 12 experienced a strong antidepressant response within hours of receiving ketamine, and for six patients the response lasted a week or more. As Zarate describes it, the subjects reported that their depression "lifted"..."

The most important questions remain unanswered -"Still, ketamine has a long way to go before it can prove itself as an antidepressant. Both Krystal and Zarate restricted their patients to a single infusion, so it remains unclear whether a second dose of ketamine would work; equally unclear is whether ketamine would carry on relieving depression if given regularly, or whether this would even be practical given the side effects and cost."

Still, the fact that a compound exists that for some can lift depression very quickly and can last for a week or longer is encouraging. What we need now are much larger studies that look at continued use of ketamine over time - more importantly we need pharmaceuticals to invest in research looking at the glutamate system in relation to depression.

Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist and is approved for human use but is mainly used by veterinarians as an anaesthetic. In the study the dosage was given intravenously.

More info on ketamine and depression at NIMH, MedPage Today, Forbes, BBC, The Boston Globe, here, Brown Univ. health education, and Primary Psychiatry.

Abstract in Arch Gen Psychiatry. 2006;63:856-864,

General info at Wiki - where you find this fact that might make you think twice about using recreational ketamine to self medicate for depression "Unlike true psychedelics, ketamine is powerfully reinforcing to many users and compulsive use is frequently reported. Both ketamine pioneer John Lilly and pseudonymous author D.M. Turner reported prolonged periods of 'ketamine dependency', and the latter drowned in a bathtub while on ketamine."

Things to worry about if you are thinking of getting ketamine on the street to use for depression:

  • risk of contamination
  • how will you know for sure what dose you are taking?
  • addictive?
  • long term health effects- neurotoxic?
  • you're messing with an anaesthetic... not a trivial matter if you have poor judgement and or suicidal impulses
  • contraindications?
  • also the research is on a very small number of people - success rates are bound to lower in a larger study - and side effects usually increase

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