Australian Study Results - Can Ketamine Cure Clinical Depression?

[CLICKHEREx]

http://www.vocativ.com/underworld/drugs/can-ketamine-cure-clinical-depression/


The results of a two-year study show the powerful tranquilizer-turned-party-drug could be a secret weapon
Author: Luke Malone
Posted: 06/10/14


The word ketamine is normally synonymous with clubbing or prepping horses for surgery, but a new study highlights its potential to combat hard-to-treat depression. First developed as a powerful dissociative anesthetic for humans and animals in 1970, the drug’s euphoric and hallucinatory side-effects saw it co-opted as a party favor. Now the focus is back on the tranquilizer’s medicinal capabilities as a potentially revolutionary, fast-acting antidepressant.

This week, researchers from Australia’s University of New South Wales’ School of Psychiatry released the results of a two-year pilot study that looks at the dosage required to balance maximum efficacy and tolerability. It builds upon earlier research that shows a correlation between ketamine and antidepressant effects—with participants reporting an elevated mood within 24 hours of taking a single dose—but these new findings on the most effective methods of administration bring it closer to becoming a viable, publicly accessible treatment option.

“For many drugs, how well it works and side effects are related to dosage. Thus finding the right dose for each person is important,” says study author Colleen Loo. “Our study is the first to systematically examine each person’s response to a range of doses. This is important for the individual patient because we have demonstrated a method to individualize the dose for each person, thus optimizing therapeutic effects and minimizing side effects.”
Ketamine Cure Depression_01

Using ketamine to treat clinical depression may soon be a reality.
AFP/Getty Images

For the study, Loo and her colleagues recruited four individuals whose clinical depression had not responded to traditional antidepressants or more invasive methods such as electroconvulsive therapy. Using double blind conditions they administered a range of ketamine doses both intravenously and via a small needle under the skin, a similar technique used by diabetics to inject insulin. Three of the four participants “achieved antidepressant response” within 72 hours, though these responses subsided within one week. Side effects including hallucinations and altered perception of reality were experienced at higher doses, though they subsided within 30 minutes and didn’t require intervention.

Loo says researchers aren’t sure how ketamine works to improve depressive symptoms. They do know that it interacts with an individual’s neurotransmitter system and that animal studies suggests it reverses the shrinkage of brain cells that occur with depression, but are still trying to figure out exactly how.

Regardless, it’s good news for people living with clinical depression. Selective serotonin re-uptake inhibitors (SSRIs) such as Prozac and Paxil can take between two and four weeks to take effect, if they work at all. Loo says that ketamine, administered in a hospital setting under strict controls, may be useful to initiate a rapid response given together with other treatments which take longer to work, or it may be an effective treatment on its own. One of her subjects met the criteria for remission after receiving the highest dose, and she believes that repeat treatments have the potential to result in full remission—which would effectively cure depression in some patients.

“From what I have seen so far, it will definitely have clinical benefits for some depressed patients. The speed and magnitude of antidepressant response are impressive, side effects are transient and, under medical supervision, it’s safe,” she says, adding that there is still more work to be done. “We are still working out which patients will benefit from ketamine, why it leads to a lasting remission in some and not others, and how to give the drug to optimize effects and gain a lasting response.”

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Cure is an inappropriate term, at least at this stage, but it should be regarded as a valid treatment, particularly in cases of clinical / major depression involving suicidal intent / attempts, (as opposed to suicidal ideation) where SSRI antidepressants take too long to become effective, but during that process it is thought that the ability to plan, and the motivation to carry out such attempts, which was previously lacking, then becomes a capability, but the antidepressant effect takes longer to kick in, with people who had survived for some time finally succeeding soon after beginning antidepressants.

"Side effects including hallucinations and altered perception of reality were experienced at higher doses, though they subsided within 30 minutes and didn’t require intervention" -

From Bluelight, via http://www.tripme.co.nz/forums/showthread.php?11786-Ketamine-Nasal-Spray-(finally)

"Investigators found that among the 18 patients completing two treatment days with ketamine or saline, eight met response criteria to ketamine within 24 hours versus one on saline. Ketamine proved safe with minimal dissociative effects or changes in blood pressure.

The study randomized 20 patients with major depressive disorder to ketamine (a single 50 mg dose) or saline in a double-blind, crossover study.

Change in depression severity was measured using the Montgomery-Asberg Depression Rating Scale. Secondary outcomes included the durability of response, changes in self-reports of depression, anxiety, and the proportion of responders.

“One of the primary effects of ketamine in the brain is to block the NMDA [N-methyl-d-aspartate] glutamate receptor,” said James W. Murrough, M.D.

“There is an urgent clinical need for new treatments for depression with novel mechanisms of action. With further research and development, this could lay the groundwork for using NMDA targeted treatments for major depressive disorder.”

“We found intranasal ketamine to be well-tolerated with few side effects,” said psychiatrist and researcher Kyle Lapidus, M.D., Ph.D.

One of the most common NMDA receptor antagonists, ketamine is an FDA-approved anesthetic. It has been used in animals and humans for years.

However, ketamine has also been a drug of abuse and can lead to untoward psychiatric or cognitive problems when misused.

Nevertheless, in low doses, ketamine shows promise in providing rapid relief of depression, with tolerable side effects".


It's now time for a larger scale, randomised double blind study using low dosage, nasally administered ketamine, or saline, to achieve statistically significant results. Ideally, such a study would subdivide into those people suffering from depression, dysthymia (a more moderate, longer lasting form of the disorder) and those with clinical / major depression.

Edited June 11, 2014 by CLICKHEREx