Ketamine & depression NEWS

[woof woof woof]

http://psychcentral.com/news/2013/05/19/ketamine-may-benefit-those-with-treatment-resistant-depression/54996.html

Ketamine May Benefit Those With Treatment-Resistant Depression

By Janice Wood Associate News Editor
Reviewed by John M. Grohol, Psy.D. on May 19, 2013

Patients with treatment-resistant major depression saw dramatic improvement after treatment with ketamine, according to results from a clinical trial.

According to researchers from the Icahn School of Medicine at Mount Sinai Hospital in New York City, the antidepressant benefits of ketamine, normally used as an anesthetic, were seen within 24 hours. Traditional antidepressants can take days or even weeks to demonstrate a reduction in depression, researchers noted.

Led by psychiatrists Drs. Dan Iosifescu, of Mount Sinai, Sanjay Mathew of Houston’s Baylor College of Medicine; and James Murrough, at Mount Sinai, the research team evaluated 72 people with treatment-resistant depression, which means their depression failed to respond to two or more medications.

These patients were administered a single intravenous infusion of ketamine for 40 minutes or an active placebo of midazolam, another type of anesthetic without antidepressant properties.

Patients were interviewed after 24 hours and again after seven days.

According to the researchers, after 24 hours, the response rate was 63.8 percent in the ketamine group compared to 28 percent in the placebo group.

The response to ketamine, however, did not last for most, with only 45.7 percent reporting benefits seven days after treatment. Only 18 percent of people in the placebo group reported such benefit after a week.

“Using midazolam as an active placebo allowed us to independently assess the antidepressant benefit of ketamine, excluding any anesthetic effects,” said Murrough, who is first author on the new study. “Ketamine continues to show significant promise as a new treatment option for patients with severe and refractory forms of depression.”

Major depression is caused by a breakdown in communication between nerve cells in the brain, a process involving chemicals called neurotransmitters, the researchers explained. Traditional antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), influence the activity of the neurotransmitters serotonin and noreprenephrine to reduce depression, though the exact mechanism is not known.

But these medications can take a long time to make a difference — and up to 60 percent of people do not respond to treatment, according to the U.S Department of Health and Human Services.

Ketamine works differently than traditional antidepressants in that it influences the activity of the glutamine neurotransmitter to help restore the dysfunctional communication between nerve cells in the depressed brain, the researchers said. It also works much more quickly than traditional antidepressants.

Further studies are needed to investigate the longer term safety and efficacy of ketamine in depression, according to Murrough.

He recently published a preliminary report in the journal Biological Psychiatry on the safety and efficacy of ketamine given three times weekly for two weeks in patients with treatment-resistant depression.

Because ketamine is a short-acting drug, it must be injected multiple times a week in order for a person to continue to receive its antidepressant effects. Longitudinal studies on its long-term use over the course of months or even years have not yet been done, so its long-term effects on a person’s health remain unknown.

“We found that ketamine was safe and well-tolerated and that patients who demonstrated a rapid antidepressant effect after starting ketamine were able to maintain the response throughout the course of the study,” he said. “Larger placebo-controlled studies will be required to more fully determine the safety and efficacy profile of ketamine in depression.”

“Major depression is one of the most prevalent and costly illnesses in the world, and yet currently available treatments fall far short of alleviating this burden,” said Dr. Dennis Charney, Anne and Joel Ehrenkranz Dean of the Icahn School of Medicine at Mount Sinai. Charney was among the researchers who discovered the potential of ketamine for treating depression.

“There is an urgent need for new, fast-acting therapies, and ketamine shows important potential in filling that void,” he said.

Source: The Mount Sinai Hospital/Mount Sinai School of Medicine

[Thelema]

urm...like developing something similar that can be orally ingested and lasts longer?

Duh, MXE.

[Anodyne]

They're recruiting for a similar study in Sydney now.

Oral ketamine has been used for chronic pain & other depression-trials - I assume they IV'ed it in this case either for convenience or to prevent diversion.

But yeah...MXE. These ketamine trials are promising though, maybe they'll get around to it next - those hints of serotonergic effects in that British study suggest it might be superior in respects other than duration too.

[gtarman]

Right on. I was first introduced to the concept of these dissociatives as antidepressants in a Vice interview with the dude/chemist who created/discovered MXE and several other similar structures. Really interesting read if you've got the time and haven't seen it already:

http://www.vice.com/read/interview-with-ketamine-chemist-704-v18n2

[PhoenixSon]

great read, really open story really.

was nice to read over it again cheers.

[SunChaser]

Patients were interviewed after 24 hours and again after seven days.

According to the researchers, after 24 hours, the response rate was 63.8 percent in the ketamine group compared to 28 percent in the placebo group.

The response to ketamine, however, did not last for most, with only 45.7 percent reporting benefits seven days after treatment. Only 18 percent of people in the placebo group reported such benefit after a week.

But if a person injested basically any popular recreational drug, then isn’t it just obvious that they are likely going to be feeling fabulous after 24 hours? And wouldn’t most people still be cruising along after 7 days if they hadn’t managed to burn themselves out yet? From what logic can that be used as evidence as an effective long-term treatment for depression?

I mean, I doubt it would come as a surprise to anyone here that ingesting most recreational drugs usually causes you to feel brilliant at first. But I personally doubt ketamine (or any drug for that matter) can give a person a long-term sense of significance or purpose in life and cause that brain chemistry to start flowing like it’s supposed too.

imo, the only way to truly treat depression is though a healthy diet, lot’s of exercise, at least 7 hours sleep every night and by doing something productive for 8 hours a day. Not an easy feat to accomplish when you’re in the pits of a depressive state, I know, but it is the only real way out, imo. There’s no magic pill to cure depression, true happiness comes from within and not from a chemical. There’s no chemical solution to a spiritual issue.

[nothinghead]

^The short but quick acting nature of ketamine on depression is typically what gets it attention as currently there are a lack of effective treatments for, say, suicidal depressive states. I don't think ketamine is being proposed as a long term solution for treating depression, more as an emergency measure since SSRIs or your method of exercise, sleep, and productive work take time to begin being effective, if they work at all.

[gtarman]

I think in an ideal world no medication would be a long-term solution to a problem like depression, but it's definitely not an ideal world. And I think that MXE etc sounded as promising as any drug solution might be, just based on what I've heard and read (which is admittedly not a tonne, so don't just take my word on it) and making sure you mind the dosage and refrain from abusing it. But I really don't know enough about these substances to make any well-informed comment.

Though I will put forward that so many different kinds of problems and illnesses (which can often be quite separate things from one another) get lumped under the vague catch-all of "depression" that it's very difficult to have a meaningful discussion about what ought to be done about it. The semantics are just all over the place.

Edited May 22, 2013 by gtarman

[Thelema]

sad to learn today that MXE has just been listed as a customs-prohibited drug.