Ketamine – is it the new hope for depression?

Light At The End Of The Tunnel

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…

 

Additional insights:

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

 

Image source

Novel drugs for depression – The Economist

depression

The Economist took a deep plunge into mental health research for depression. The article is extremely interesting as it seems that the scientific community understands depression a bit more than before. Despite the lack of interest from the industry, old drugs like ketamine seem to be very useful in treating that disorder. In order to patent their invention, new drugs with the same benefits as ketamine are being developed by pharmaceuticals companies.

Even if we do not yet have a complete picture, we took a step in the right direction.

Article link

Image source

The opioid pain drug misuse problem solved?

Children's_pain_scale

Today using opioids to treat chronic pain seems quite obvious for a lot of clinicians. This trivialization, beyond the responsibility of both the clinician and the patient, is responsible for the dramatic increase of opioid misuses and overdoses.

An excellent article written by Dr. Daniel Alford in the last issue of NEJM proposed smart solutions. Prescriber education is one of them. It would allow a more specific approach to addressing the opioid-misuse epidemic: benefit-risk assessment of patient’s needs and care individualization. It should be completed with patient close follow-up and monitoring as well as the careful evaluation at each encounter of whether to start, continue, decrease, increase or stop the treatment.

Training should start early in the medical education and students have to be aware of the best practices for that type of prescription. All the options for chronic pain management have to be taught and not only to doctors but to all healthcare providers in order to tackle the lack of awareness and education in the field.

Beyond drugs, other alternatives should be tested and proposed, especially when an opioid-based treatment is stopped. Explanations have to be provided in order to reassure the patient that his/her pain is manageable without this type of drugs.

The whole discussion, and a whole lot of other healthcare themes, are closely linked to the doctor-patient relationship. Trust, collaboration and open discussion are all key in order to have the best outcomes for the patient.

As a conclusion, I would like to invite you to watch the fantastic talk given by Elliot Krane, an expert in chronic pain about how this disease invades the body, what are the treatment options and what’s next.

 

Additional information:

Overdose Death Rates – US National Institute on Drug Abuse

Understanding the Epidemic – US Centers for Disease Control and Prevention

How drug use changes the brain — and makes relapse all too common – STAT – April 2017

The Painkillers That Could End the Opioid Crisis – MIT Technology Review – August 2016

Opioid Prescribing for Chronic Pain — Achieving the Right Balance through Education – NEJM – February 2016

Mortality Trends Among Working-Age Whites: The Untold Story – The Commonwealth Fund – January 2016

Trends in Opioid Analgesic Abuse and Mortality in the United States – NEJM – January 2015

When Pain Kills – AARP – September 2015

Opioid Addiction Facts and Figures – ASAM

Assessment & Management of Chronic Pain – Healthcare Guideline – ICSI – November 2013

 

Image Source

The world’s first true “smart drug” enhances cognition and is deemed safe by health experts

Serendipity or “making discoveries, by accidents and sagacity, of things which we were not in quest of” is again one of the best source for innovation in the drug industry.
This is the story of a sleep disorder pill (modafinil or Provigil) that has been deemed the first pure cognitive enhancer.

Why Are We Failing To Fund Mental Health Research?

Insightful post on the reasons of mental health underfunding.

Snackable Science

Everyone is affected by mental illness in some capacity, either directly or through those that we know. Around a quarter of the population experience a mental health condition each year and this high prevalence has considerable repercussions, both socially and economically. Indeed, many would be surprised to hear that on top of obvious human suffering, mental illness is estimated to cost the UK an eye-watering £105 billion a year once healthcare expenses and lost productivity have been taken into account.

With mental illness disrupting the lives of so many and harming the economy to such an extent, I was genuinely surprised to hear of the funding gap that exists in mental health research. Compared to other diseases that place a similar burden on society, publicly funded research into mental health is disproportionately low. Cancer research provides some of the strongest evidence of this effect, receiving around 20% of total UK research expenditure, almost four times more than the amount invested…

View original post 430 more words

The Integration of Care for Mental Health into Primary Care – American College of Physicians Position Paper

MentalHealthStigma

Integrate mental health into primary care to deliver better outcomes for the patients

A new position paper (subscription required) published by the American College of Physicians is focusing on the integration of mental health care into primary care in order to improve outcomes

Mental health disorders have been estimated to be a major burden by 2020 by WHO.  They are “linked to increased physical illness, higher mortality rates, poorer treatment outcomes and higher healthcare costs”.

Mental health conditions are not always properly diagnosed because of stigma and financial barriers such as insurance coverage gaps. These are the reasons behind the “call for the use of the primary care delivery platform and the related patient-centered medical home model to effectively address these conditions” as stated in the position paper. Health care providers will have to be trained to ask difficult questions, diagnose and treat these diseases.

 

Additional resources

Use data to challenge mental-health stigma – 2015 – Nature

Treat ‘whole person’ by bringing behavioral health into primary care: docs – 2015 – Reuters

The Global Burden of Mental, Neurological and Substance Use Disorders: An Analysis from the Global Burden of Disease Study 2010 – 2015 – Harvey A. Whiteford

Global Burden of Neurological and Mental Disorders – 2014 – Brain Facts

 

Image source

Economic crisis, health systems and health in Europe – WHO European Observatory

austerity

How did European Countries cope with the economic crisis and its impact on their national health system?

The last report published by the WHO European Observatory on Health and Health Systems on the impact of the economic crisis on health and health systems allows to take a step back and look at the deterioration of health care in the context of an economic crisis over the last few years in several European countries. It is a desk reference where it is easy to pick the country or the countries that are of interest. Austerity measures have a huge impact on the quality as well as quantity of care in specific countries. Too much cost cutting leads to catastrophic situations, like in Greece.

The structure of the report:

– In the 1st part of the report, 9 countries were chosen for in-depth analysis: Belgium, Estonia, France, Greece, Ireland, Latvia, Lithuania, Netherlands and Portugal. These are probably the most impacted by the economic crisis.

– In the 2nd part of the report, all the countries are covered with regards to their response to the crisis. For each country analyzed in this part, economic trends are evaluated as well as policy responses. Changes are then detailed by category: adjustments to public funding for the health system (budget cut, reforms, subsidies, insurance premiums, cost-containment measures,…), variations to health coverage (population, benefits, user charges,…), revisions to health service planning, purchasing and delivery (price of medical goods, salaries and motivation of health sector workers, payment to providers, overhead costs, provider infrastructure and capital investment, priority setting to change access to treatments, waiting times, prevention,…).

 

Additional resources:

Health and Financial Crisis Monitor – Always up to date

Systematic Review on Health Resilience to Economic Crises – 2015 – PLOSOne

Health, Austerity and Economic Crisis – 2014 – OECD Health Working Paper n. 76

European economic crisis and health inequities: research challenges in an uncertain scenario – 2014 – International Journal for Equity in Health

Effects of the economic crisis on health and healthcare in Greece in the literature from 2009 to 2013: A systematic review – 2014 – Health Policy

Impact of Austerity on European Pharmaceutical Policy and Pricing – 2013 – Deloitte Centre for Health Solutions

Financial crisis, austerity, and health in Europe – 2013 – The Lancet

Global Health and the Global Economic Crisis – 2011 – American Journal of Public Health

 

Image Source

A first big step toward mapping the human brain – Wired

brain

The human brain has always been a secret black box but it could change…

Understanding the human brain is close to reach a first milestone: DATABASE. “When it’s complete, the database will be the first in the world to collect information from individual cells along four basic but crucial variables: cell shape, gene expression, position in the brain, and electrical activity.” (Wired Article quote)

Several institutions are working to increase the knowledge about our most important organ: Human Brain Project (Europe), BRAIN Initiative (US).

“The big plan is to try to understand how the brain works,” says Lydia Ng, director of technology for the database. “Cell types are one of the building blocks of the brain, and by making a big model of how they’re put together, we can understand all the activity that goes into perceiving something and creating an action based on that perception.” (Wired Article quote)

We are just at the beginning of a fascinating journey in our brain. Up to now, researchers only have been able to have a big picture about the functioning of the cells together. It is still unclear how billions of neurons act together resulting in patterns of behavior and activation.

Wired Article

More on human brain research:

TED Videos on Brain – From brain plasticity to the understanding of consciousnes through the paradox of choice among others… Intriguing topics around the brain!

Brain Basics: Know Your Brain – 2015

Human Brain: Facts, Anatomy & Mapping Project – 2015

Brain & Nervous System Health Center – WebMD – 2014

8 Things We Simply Don’t Understand About the Human Brain – io9

Introduction: The Human Brain – 2006

 

Image Source

What if we prescribed video games, and not Ritalin, to treat ADHD? – Medium

gamers

How digital games can inspire and motivate children — and result in better learning outcomes

An extremely interesting article on gaming and its impact on children learning skills will maybe lead to the prescription of game sessions in the treatment of psychological ailments.

We are entering in an emerging field called therapeutic neurogaming.

“It’s built on two basic ideas: First, that the brain is “plastic” for far longer than scientists once believed, so healing can be achieved in schoolchildren of all ages without drugs, through basic neurofeedback therapy. Second, that therapy doesn’t just happen — it requires work and patience and a regular dose of practice.” (Quote from Medium Article)

I’m a strong believer that games will be fully part of our lives and not only part of our hobbies in the near future.

Three years ago I read a book written by Jane McGonigal, an expert in gaming and gamification: Reality is broken. I have only one word: brilliant. She walks you through the gaming universe explaining you all the type of games and how they can be used to improve life, well-being, relationships,… She is about to publish another book in September 2015: SuperBetter: A Revolutionary Approach to Getting Stronger, Happier, Braver and More Resilient–Powered by the Science of Games. I’m really looking forward to it.

It is a real trend we have to count on. The nice fact: it is not a boring trend… it is fun!! and there is probably more to come!!

Medium Article

More on the benefits of gaming:

The Game Believes in You: How Digital Play Can Make Our Kids Smarter – 2015 – Greg Toppo

Cognitive Benefits of Playing Video Games – 2015 – Psychology Today

The Benefits of Playing Video Games – 2014 – American Psychologist

The DeanBeat: Neurogaming is a nascent market fueled by brain games and sensors – 2013 – Venture Beat

Reality Is Broken: Why Games Make Us Better and How They Can Change the World – 2011 – Jane McGonigal + her TED Talk

Gamification to improve our world – 2011 – Yu Kai Chu – TEDxLausanne

Companies or Institutions developing therapeutic neurogaming:

Gazzaley Lab (Neuroracer)

Akili Interactive Lab (Project: EVO)

PlayNice Institute (MindLight)

PuzzleBox (Orbit Helicopter)

Emotiv (EEG for game control)

 

Image Source

Mental Health – Awareness and Care vs. Stigma

DepressionMental Health Awareness is Starting to win over Stigma

During the last week I read several articles on mental health (you can see the list at the bottom of my post). I think that there is something going on, more awareness on how sick or sad people feel and what can we do about it. It has been found by a recent study that if nothing is done, the burden would be unbearable in the coming years.

Marilyn Wedge has wonderful insights in her article. Some of her quotes are revealing the sick and sad truth about our society:

– “The notion of mental health or mental illness is relative to the values of a particular society at a particular time in history. Our hectic society paradoxically frowns on overly active children—even children as young as four or five years old. Our society wants children to be restrained, orderly, and eager to please adults.”

– “There is another aspect of ADHD that worries me. As stimulants have come to be prescribed for ever larger numbers of children, our society’s very perception of childhood has changed. Instead of seeing ADHD-type behaviors as part of the spectrum of normal childhood that most kids eventually grow out of, or as responses to bumps or rough patches in a child’s life, we cluster these behaviors into a discrete (and chronic) “illness” or “mental health condition” with clearly defined boundaries. And we are led to believe that this “illness” is rooted in the child’s genetic makeup and requires treatment with psychiatric medication.”

– “In Prozac Nation, Elizabeth Wurtzel also discusses the one drug/one disease phenomenon. She says that her doctors defined her illness as “depression” because she responded to a specific antidepressant drug, Prozac. The drug defined her disease. Like Kramer, Wurtzel also noticed that a psychiatric drug not only came to define a particular mental disorder, but the drug also expanded that disorder across society. She observed, too, that the process was driven by profits to drug companies. The discovery of a new drug to treat depression resulted in many more patients being diagnosed with depression.”

– “As Wurtzel points out, the process of defining a disease by a drug is illogical and backward. Medicine has traditionally defined diseases by their causes, not by the drugs to which patients with similar symptoms respond. If psychiatry aspires to be scientific, on a par with other branches of medicine, how can it be content with this peculiar practice of delineating the outlines of a disease by a drug treatment?”

In conclusion, we really need to change the perception of our human behaviors: normality doesn’t exist and will never exist. We are all different and we have to accept ourselves with our own personality and identity. Something is changing and I hope that more people will find relief by being accepted as they are (as a starting point!).

 

Out of the shadows – 2015 – The Economist

The ADHD Fallacy: It’s Time To Stop Treating Childhood as a Disease – 2015 – TIME

It’s Time To Stop Using These Phrases When It Comes To Mental Illness – 2015 – Huffington Post

Probiotics May One Day Be Used To Treat Depression – 2015 – Huffington Post

Mental Health and Integration – 2014 – The Economist Intelligence Unit & Janssen

Mental Health Atlas – 2011 – WHO

 

Image Source