Ketamine Can Quickly Relieve Hard-to-Treat Depression Health Info

By Amy Norton Health Day Reporter

(Health day)

MONDAY, December 27, 2021 (HealthDay News) – Ketamine, once best known as a “club” drug, can quickly improve difficult-to-treat depression and curb suicidal thoughts, a new review confirms.

In recent years, ketamine has become something of a wonder drug for some people who don’t get better with standard antidepressants.

For patients who may have tried several conventional medications, ketamine can relieve symptoms of depression quickly, even within a day. Experts say a quick response is especially critical for people at risk for self-harm.

The new review, recently published in the British Journal of Psychiatry Open, brings together all the published research on ketamine as a treatment for psychiatric disorders. And he found that for treatment-resistant depression and suicidal thoughts, the drug can have quick and “robust” effects – albeit short-lived.

“It is important to stress that the drug does not work for everyone,” said lead researcher Celia Morgan, professor at the University of Exeter in England.

Ketamine is also not easy to take. It must be administered under medical supervision, Morgan noted, so that doctors can watch for “dissociative” effects – or what laymen might call a “trip.”

The drug is not a psychedelic, but usually triggers altered perceptions of reality, such as hallucinations, soon after it is administered. It can also cause a short-term rise in blood pressure, Morgan said.

So, before anyone tries ketamine for depression, she said, they must undergo a full medical and psychiatric evaluation to make sure it’s right for them.

Ketamine was first approved in the United States decades ago as an anesthetic drug. Due to its psychotropic effects, it has also come to be abused as a party drug, known by nicknames such as “Special K”.

But researchers have long been aware of the drug’s potential, in low doses under well-controlled conditions, to treat psychiatric symptoms. Ketamine is not approved by the United States Food and Drug Administration for the treatment of depression. But doctors can and do prescribe it “off label” for this reason.

And in 2019, the FDA approved a derivative of ketamine – called esketamine (Spravato) – for depression that failed to respond to at least two standard antidepressants.

Unlike ketamine, which is given intravenously, esketamine is a nasal spray. But it must still be administered under medical supervision, as it has the same side effects.

Since esketamine is FDA approved for depression, it has become the more practical choice over ketamine, according to psychiatrists not involved in the review.

“It’s much easier to get insurance coverage for esketamine,” said Dr. Paul Nestadt, co-director of the Johns Hopkins Anxiety Disorders Clinic in Baltimore.

So, while he was involved in ketamine research, Nestadt said that in practice he prescribed esketamine.

It’s not entirely clear how either drug relieves depression so quickly. But researchers know that ketamine has different brain targets than standard antidepressants, and that includes increasing the activity of a chemical called glutamate, which helps brain cells communicate with each other. Studies also suggest that ketamine promotes regrowth of synapses – connections between brain cells that can be depleted in people with long-standing depression.

With esketamine, Nestadt said, there is a definite treatment protocol: it is used in combination with a standard antidepressant, starting with two doses per week for the first month, then a weekly dose for the next month, and then continuing on. gradually decreasing thereafter.

The length of this maintenance period, however, is “indefinite,” said Dr. Joshua Berman, assistant professor of psychiatry at Columbia University Irving Medical Center in New York City.

In the early years of research, he noted, the focus was on understanding the rapid effects of ketamine.

“We, collectively, have never seen anything like it,” Berman said.

Now, the current research question is: How long do the antidepressant effects really last?

It is also not clear, according to the review, whether ketamine helps with other psychiatric disorders, such as post-traumatic stress disorder, obsessive-compulsive disorder and substance abuse.

Researchers looked at 89 published studies, some of which tested ketamine for these short-term conditions. But while there were “positive” effects, Morgan’s team said, the results should be interpreted with caution at this point.

For people with depression, Berman and Nestadt stressed the importance of a full psychiatric evaluation, along with a medical history, before starting to take ketamine or esketamine.

There are ketamine “clinics” in the United States, but some are run by anesthetists, not mental health professionals.

“[Ketamine] is not a first-line treatment for depression, “Nestadt stressed.” You want a good assessment first, and you should start with treatments that have been studied for decades. “

In addition, Nestadt said he keeps patients on their current treatment – antidepressants as well as talk therapy – during the esketamine procedure. And while the maintenance phase of esketamine is not clearly defined, neither esketamine nor ketamine is meant to be given “indefinitely,” Nestadt said.

Berman pointed out an additional reason for being in the care of a mental health professional: If ketamine isn’t working, patients should have other options presented to them.

SOURCES: Celia Morgan, PhD, professor, psychopharmacology, University of Exeter, England; Joshua Berman, MD, Ph.D., assistant professor, psychiatry, Columbia University Irving Medical Center, New York; Paul Nestadt, MD, assistant professor, psychiatry and behavioral sciences, co-director, Johns Hopkins Anxiety Disorders Clinic, Johns Hopkins University School of Medicine, Baltimore; British Journal of Psychiatry Open, December 22, 2021, online

Copyright © 2021 Health Day. All rights reserved.

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