Ketamine is a sedative first synthesized in 1962; its patents have long elapsed and it costs pennies; it has many uses and is also sold illegally for use as a recreational drug, but in recent years it has been used with remarkable efficacy as a treatment for a variety of disorders, including depression, anxiety, and chronic pain (I have lifelong chronic pain and my specialist has prescribed very low doses of it for me at bedtime).
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Earlier today, the FDA approved esketamine (brand name Spravato), a chemical twin of the dissociative psychedelic/anaesthetic ketamine (Special K), as a treatment for depression. Spravato comes in nasal spray form meant to be administered weekly or every other week depending on the severity of the patient's depression.
"There has been a longstanding need for additional effective treatments for treatment-resistant depression, a serious and life-threatening condition," said the FDA's acting director of the Division of Psychiatry Products, Dr. Tiffany Farchione, in a press release. "Because of [safety] concerns, the drug will only be available through a restricted distribution system and it must be administered in a certified medical office where the health care provider can monitor the patient."
From National Public Radio:
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Many doctors who have become comfortable offering ketamine for depression probably won't switch to esketamine, said Dr. Demitri Papolos, director of research for the Juvenile Bipolar Research Foundation and a clinical associate professor at Albert Einstein College of Medicine.
For the past 10 years, Papolos has been prescribing an intranasal form of ketamine for children and adolescents who have a disorder that includes symptoms of depression.
"I'm very pleased that finally the FDA has approved a form of ketamine for treatment-resistant mood disorders," Papolos said. He said the approval legitimizes the approach he and other doctors have been taking.
But he hopes that doctors who are currently using ketamine continue to do so. "It'll be a lot less expensive and a lot easier for their patients [than esketamine]," he said.
Ketamine is a short-acting dissociative anesthetic commonly used on animals and sometimes people. Of course it's also beloved by many psychonauts for its unusual dreamlike or "out of body" psychedelic effects. While Ketamine has been shown for years to help treat depression, anxiety, and obsessive-compulsive disorder in adults, researchers at Yale School of Medicine now report that it has great promise as a fast-acting intervention for children in crisis. From Scientific American:
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It was less dramatic to watch than I expected, but the kids were definitely high. There was a lot of giggling involved, and they often said that they felt like time was changing and that their bodies felt ‘funny’ and sometimes numb. Nicole, (a suicidal 14-year-old,) admitted, “I’m not gonna lie. I like the feeling of it.”
Perhaps more dramatic than the trips themselves, which happened in a carefully controlled procedure room with a psychiatrist and anesthesiologist ready to intervene if needed, were the interviews that came after. I could see the weight of depression lifted from these patients within hours. Adolescents who were previously ready to end their own lives became bright and hopeful. Psychiatry has never seen a drug intervention so powerful and fast acting. While most anti-depressants take weeks to work and offer modest improvement, ketamine offers dramatic improvement in less than a day...
Dr. Michael Bloch, Yale child psychiatrist and principal investigator of several controlled trials for ketamine for adolescents, points out that the drug is only used for select patients who have severe mental health problems that have not responded to other medications.
Ketamine, a tranquilizer/anesthetic and recreational drug, can relieve symptoms of depression for up to a couple of weeks, writes psychiatrist Emily Deans.
In a recent paper, researchers described how they used a noncompetitive inhibitor of the NMDA receptor and partial dopamine receptor agonist, ketamine to rapidly reverse the symptoms of anhedonia in depressed patients. Ketamine has been featured on CBS news for its ability to quickly relieve depression unlike any other pharmacologic agent we have. It is typically used intravenously, and can cause hallucinations and dissociation (in fact it is also known as the club drug “Special K"). However, it seems to be able to reverse damage to the synapses caused by chronic stress, and relieve the symptoms of depression very quickly, within 30-40 minutes.
The down side to ketamine (besides lack of FDA approval for depression, the hallucinations, and lack of general availability) is that the effects don’t last. If you are lucky, you get a couple of weeks, then the depression comes back. Researchers and doctors, however, are hoping ketamine could be used as a bridging agent in seriously depressed, hospitalized patients, allowing them to feel better immediately while other, longer acting but much slower onset agents have a chance to get into the system and do their work. The immediate reversal of the key symptom of anhedonia [inability to experience pleasure] may be an even more important lesson we can learn from the use of ketamine.
The Ketamine Key: The horse tranquilizer helps depressed patients experience pleasure again Read the rest