It is either the most exciting new treatment for depression in years or it is a hallucinogenic club drug that is wrongly being dispensed to desperate patients in a growing number of clinics around the country.
While it has been used as an anesthetic for decades, small studies at prestigious medical centers like Yale, Mount Sinai and the National Institute of Mental Health suggest it can relieve depression in many people who are not helped by widely used conventional antidepressants like Prozac or Lexapro.
And the depression seems to melt away within hours, rather than the weeks typically required for a conventional antidepressant.
But some psychiatrists say the drug has not been studied enough to be ready for use outside of clinical trials, and they are alarmed that clinics are springing up to offer ketamine treatments, charging hundreds of dollars for sessions that must be repeated many times.
Pharmaceutical companies hope to solve the problem by developing drugs that work like ketamine but without the side effects, which are often described as out-of-body experiences.
“It’s definitely the most promising compound in the depression space in terms of effect and durability,”
But achieving safety and efficacy for this type of drug can be challenging, and some attempts have failed
Some doctors and patients are not waiting for the pharmaceutical industry. Because ketamine has long been approved for anesthesia, doctors are allowed to use it off-label to treat depression.
Clinics charge from $300 to more than $1,000 per treatment. Insurance rarely covers the cost. Schedules vary by clinic and by patient, but some patients are treated every few days at first, then every two weeks to two months.
Besides the psychoticlike effects, ketamine can raise blood pressure and heart rate.
Some patients say they are ready to take that risk.“I look at the cost of not using ketamine — for me it was certain death,” said Dennis Hartman, 48, a businessman from Seattle.
he had chosen a suicide date when he entered a clinical trial of ketamine at the National Institutes of Health two years ago. His depression lifted and since then he has gone to a clinic in New York every two months or so for infusions. He started the Ketamine Advocacy Network to raise awareness of the treatment.
Advocates say that the dose used for depression is smaller than that used for anesthesia or by abusers and can be given safely.
A common refrain among ketamine advocates is that questions about its safety are emanating from drug companies, which have no financial incentive to develop ketamine because it is generic, but see it as a threat to their proprietary products.
“Almost half of depressed patients are not being treated adequately by existing drugs,”
That, he said, is because virtually all the antidepressants used in the last 60 years work essentially the same way. They raise levels of serotonin or one or two other neurotransmitters, chemicals that transmit signals in the brain.
Ketamine would represent a new mechanism of action. It is believed to work mainly by blocking receptors in the brain for N-methyl-D-aspartate, or NMDA, which interact with a different neurotransmitter called glutamate. The blockage sets off a cascade of changes that are not yet completely understood.
“Synaptic connections that help us to cope seem to grow back,”
The above is indeed excellent news. It seems our bodies have a tendency toward health, and will recover if we provide the right environment.
the biggest obstacle to ketamine use is not the side effects but that its effect on depression wears off so quickly.