Ketamine is an anesthetic that is safely used in both human
and veterinary medicine. It is known for its hallucinogenic and dissociative
effects and thus is also very popular recreationally. When taken in high doses,
it can cause what is known as “K hole”, or an out of body experience where you
are completely conscious but unable to control your body. For this reason, it
has also commonly been used as a date rape drug.
Janssen Pharmaceuticals, Inc. is currently applying for FDA
approval for esketamine nasal spray for use in treatment resistant Depressive Disorder.
So, why would we want to introduce an already commonly abused drug in
psychiatry? It turns out that when used in a clinically controlled setting,
esketamine may be able to overcome several large treatment barriers for
depressive disorders.
Data from the Janssen clinical trials showed a statistically
significant rapid reduction in depressive symptoms compared to the placebo
control group when administered in conjunction with an oral antidepressant.
Additionally, these studies found esketamine to be generally tolerable while
sustaining improvements on depressive symptoms with repeated dosing up to 1
year. What does this mean?
The anti-depressants currently available typically require
several weeks to take full effect and are often fraught with nasty side effects.
Speaking from my clinical experience in mental health, it was often
disheartening to see the same patients come in month after month reporting the
same symptoms and the same terrible side effects. To me, the most exciting
implication is the potential to provide quick relief to patients expressing severe
symptoms, particularly those with acute suicidal ideations.
Long-Term Phase 3 Study Shows Esketamine Nasal Spray Plus an
Oral Antidepressant Delayed Time to Relapse in Patients with
Treatment-Resistant Depression. (2018, May 31). Retrieved from https://www.janssen.com/long-term-phase-3-study-shows-esketamine-nasal-spray-plus-oral-antidepressant-delayed-time-relapse
This finding is super interesting (and exciting!). It makes me think of Alex's thesis on MDMA being used as therapy for PTSD. I wondered whether ketamine would be equally difficult to study due to FDA regulations. However, I came across an article explaining that ketamine can be used "off label" by physicians. Therefore, it seems that while ketamine is used as a recreational drug just like ecstasy is, its status as an anesthetic as well allows it to be used and studied without the red tape that MDMA studies are encountering. I wonder whether any data from these esketamine studies could be used in support of further research involving MDMA and psychologic disorders? It will be interesting to see.
ReplyDeleteIonescu, Dawn F., Kate H. Bentley, Matthias Eikermann, Norman Taylor, Oluwaseun Johnson-Akeju, Michaela B. Swee, Kara J. Pavone, et al. “Repeat-Dose Ketamine Augmentation for Treatment-Resistant Depression with Chronic Suicidal Ideation: A Randomized, Double Blind, Placebo Controlled Trial.” Journal of Affective Disorders 243 (January 15, 2019): 516–24. https://doi.org/10.1016/j.jad.2018.09.037.
I have to agree with Megan, this is super interesting and I am so intrigued by how hallucinogenic drugs are being considered for psychotherapy uses. You touched briefly on the shortcomings of the typical anti-depressant drugs and how they can take several weeks to take full effect. With ketamine acting much faster than the typically used anti-depressant drugs, I am assuming it will need to be taken more frequently to maintain effects. Has there been any discussion or evidence of addiction and dependency rates with Ketamine in a therapeutic context?
ReplyDeleteIt is very interesting to read about. Especially, the fact that its commonly known as a rape drug yet is being studied because it can help with reduction in depressive symptoms. However, my whole issue with this is that people could possibly become addicted to the feeling that they get when they receive the ketamine ultimately resulting in a temporary fix instead of a long-term fix for depression. And my other point of concern would be are the side effects more damaging than just the treatment itself, and if so to what extent compared to other prescribed anti-depressant drugs?
ReplyDeleteWould this be a long term treatment method? With a lot of anti-depressants they do not want the patient taking them for the rest of their lives due to addiction, inhibits/enhances certain neurotransmitters etc. I also think this is a short term problem, because what happens when they stop taking it? I think there are more detrimental affects in the long run. But very interesting find. I am curious how this research will proceed.
ReplyDelete