After decades of lack of innovation in the depression field, maybe patients having tried several treatment options could see the light at the end of the tunnel.
Ketamine is a potent analgesic used in surgery. As the compound is highly soluble in lipids, it ensures a rapid onset of the effects leading to a quick relief of depression symptoms without the typical side effects of standard antidepressants like SSRI.
However, there are some health consequences of administering that drug in the long term:
- CNS effects: as ketamine is considered to be a cerebral vasodilator that increases cerebral blood flow, it has anticonvulsant effects. However, its use could be limited as it has also unpleasant emergence reactions such as hallucinations, out-of-body experiences, and increased and distorted visual, tactile, and auditory sensitivity.
- Cardiovascular effects: ketamine increases blood pressure, heart rate and cardiac output.
- Respiratory effects: ketamine relaxes bronchial smooth muscles and may be helpful in patients with reactive airways and in the management of patients experiencing bronchoconstriction.
The cardiovascular effects could limit its used in depressed patients with cardiovascular conditions. Furthermore, we know that ketamine is safe when used for anesthesia but we have no idea about its long-term safety. For depression, it is given every few weeks for several months.
Another point worth to mention is the lack of reimbursement: it is not covered by any health insurance today and patients have to pay out of the pocket. Depending on the dose and the healthcare provider, it could range from USD 400 to 800 in USA.
Currently, late-stage studies are ongoing with compounds closed to ketamine developed by Johnson & Johnson and Allergan in order to fill this gap and provide patients with access to a safe and effective drug.
Thinking forward about mental health, we could maybe study psychoactive drugs more in-depth in order to discover whether they could be used in a controlled setting to ease some mental disorders.
Initiatives are launched to go into this direction. The future will tell…
Ketamine Stirs Up Hope—and Controversy—as a Depression Drug – Wired – 2019
Ketamine Could Be the Key to Reversing America’s Rising Suicide Rate – Bloomberg Businessweek – 2019
Can we stop suicide? – NYT – 2018
Psilocybin – A long, strange trip – Because psilocybin research has been restricted, scientists actually don’t know a lot about how it does what it does; only recently has that started to change. To begin with, its chemical structure is similar to the neurotransmitter serotonin. Evidence from a 2012 study suggests that psilocybin “knocks out” serotonin receptors by occupying them, which “appears to allow information to travel more freely in the brain”; two areas in which it knocks out some activity are associated with self-awareness. – Quartz – 2018
Mind molding psychedelic drugs could treat depression, and other mental illnesses – The Conversation – 2018
The Effects of Cannabis Among Adults With Chronic Pain and an Overview of General Harms: A Systematic Review – Annals of Internal Medicine – 2017
Benefits and Harms of Plant-Based Cannabis for Posttraumatic Stress Disorder: A Systematic Review – Annals of Internal Medicine – 2017
The Ketamine Breakthrough for Suicidal Children – Scientific American – 2017
New Hope for Depression – TIME – 2017
The War on Drugs Halted Research Into the Potential Benefits of Psychedelics – Slate – 2017
Scientists and Silicon Valley want to prove psychoactive drugs are healthy – The Guardian – 2016
End the Ban on Psychoactive Drug Research – Scientific American – 2014