Ketamine & depression: Changing your state of mind

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NEW HAVEN, Conn (Ivanhoe Newswire) -- One in ten adults in the US suffers from depression. For many, the symptoms are debilitating and the current treatments just don’t work. Researchers say a drug that’s used in hospitals and abused on the streets, may dramatically change your state of mind.

In hospitals, it’s a commonly used anesthetic. In the clubs, ketamine is ‘aka, Special K,’ a popular hallucinogenic drug, but what can make ketamine truly “special” for millions of people, is its potential to, quickly and effectively, treat chronic depression.

“It has been one of the major new findings in the field for at least a few decades,” Doctor Gerard Sanacora, MD., Ph.D., Professor of Psychiatry at Yale University and Director of the Yale Depression Research Program, told Ivanhoe.

Unlike standard antidepressants, which can take weeks or months to work, Yale researchers say ketamine can improve your mood in hours, “by reconnecting brain regions and allowing proper control of mood and emotion," Doctor Ron S. Duman, Ph.D., at Yale University School of Medicine, told Ivanhoe.

Even for treatment-resistant patients. However, researchers are still figuring out how to safely administer ketamine as a routine treatment. “It’s not strongly addictive, but it does have high abuse potential,” Doctor Duman said.

While ketamine is currently not FDA approved for depression, a growing number of private clinics across the country are offering it “off label.” Doctor Gerard Sanacora is concerned. “There are several very important questions that we still don’t know about ketamine and probably the most important is what is the long term benefit? Is repeating dosing of this actually a good idea,” said Doctor Sanacora.

Doctors say the fast-acting quality of ketamine can help save lives of those in danger of committing suicide. Infusions at the private ketamine clinics can run you thousands of dollars, with no guarantee of any results; they’re also not covered by insurance.

Gerard Sanacora, MD, PhD, Professor of Psychiatry at Yale University and Director of the Yale Depression Research Program, talks about a new treatment option for depression.

Can you tell us a little bit about ketamine the drug and what makes it so special? 

Dr. Sanacora: Most of the antidepressant drugs that are currently being used were developed out of the monoaminergic hypothesis, which really focuses on serotonin or norepinephrine and dopamine to some extent.  Ketamine is a very novel drug that actually targets glutamate, which is a completely different neurotransmitter system that up to this point has not really been targeted for the treatment of depression or other mood disorders. 

The other thing about ketamine is it has been around for a while.

Dr. Sanacora: Correct, ketamine is one of what is called a dissociative anesthetic class of drugs which has been around for quite a while and it is actually a very commonly used anesthetic in pediatric anesthesia or in the emergency room setting.

Who does it work best for?

Dr. Sanacora: There have not been hundreds of studies for us to really look at which patient population would benefit most from this.  There are some hints that it might work better in people with more severe depression; there are some hints that it might work better with people with certain subtypes or certain symptoms of depression, but there has also been some very preliminary studies suggesting that it might be beneficial even in cases of PTSD, and in patients that have comorbid alcohol abuse, so I think the short answer is we really do not know at this point.  It is too early to say.

What about your own clinical studies? What sort of things are you finding out?

Dr. Sanacora: We remain very interested in the mechanism by which ketamine is producing this antidepressant effect. A lot of our work is actually trying to understand the changes that occur after a dosing of ketamine that are associated with the clinical benefit. We are currently doing a lot of neuroimaging studies trying to understand exactly what ketamine is doing in the brain to generate this rapid onset of antidepressant effect. We also have several other studies looking at drugs very similar to ketamine, but maybe having fewer side effects and a little bit better safety profile that might also have the antidepressant effect.

Tell us a little bit more about the clinical studies and the research you are continuing to undertake 

Dr. Sanacora: My laboratory and our clinic are very interested in several aspects of ketamine.  We are very interested in pursuing studies that will help us learn more about the mechanism of action. What is the drug doing to the brain that is leading to these antidepressant like effects? We are also very interested in some of the very simple questions about the drug that have not been answered like what is the exact, or what is the optimal dose to be giving; how frequently can it be dosed to maintain a response, and whether other drugs that are very similar to ketamine, but potentially with a better side effect profile or safety profile, could also be used to generate the antidepressant effect without having to worry about the same side effects as you would with ketamine?

There are private clinics popping up across the US, which are offering ketamine to patients. What sort of advice would you give to people and is it a wise choice or should they be guarded about this?  

Dr. Sanacora: It is a very difficult question to answer. As we know depression is in some cases an incredibly disabling and very severe for many people. When the classic treatments have not been effective, there is a real desire to go out and get whatever treatment may be beneficial. In that sense, I think ketamine does offer some hope, but what I really caution people about is, there are several very important questions that we still do not know about ketamine and probably the most important is what is the long term benefit? Is repeated dosing of this actually a good idea? Both in terms of efficacy, does it actually work when it is used repeatedly, but also in terms of safety? We really do not have all that much information on repeated dosing in patients with depression.

How important is this research overall in the field of depression? We hear about medical breakthroughs in other areas of medicine all the time, so is this really major stuff for this area of medicine?

Dr. Sanacora: At this point, I would say it has been one of the major new findings in the field for at least a few decades. For two reasons, one is it might actually offer a more direct immediate benefit to the patients, clinical benefit for the patients, but also in terms of the scientific knowledge that it is giving us.  It has really opened up a new vista or a whole new landscape of new targets and treatments that can be developed for the treatment of depression that is not specifically ketamine by itself.

I was going to say, because ketamine is really just the tip of the iceberg. 

Dr. Sanacora: I really think ketamine is the tip of the iceberg here.  It has opened our eyes to new avenues to pursue for the treatment of not only depression, but many other neuropsychiatric disorders. 

This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.