Could ketamine become the next weapon against depression?

Author RYAN LOUGHLIN SCIENCE WIRED

SEAN SPENCER WAS ready to give up. For two years, since suffering a major panic attack, the entrepreneur had been living under a cloud of depression. Nothing seemed to make it better. He took traditional antidepressants, but they made him “want to die.” Meditation gave him a fleeting sense of relief, but it wasn’t enough to get him through the day. Out of desperation, he finally traveled to a clinic to try a controversial new therapy: ketamine IV infusions.

Ketamine, first synthesized in 1962, has long been used as a clinical anesthetic and animal tranquilizer—but it’s also known as the hallucinogenic club drug Special K. Spencer remembers being afraid of having a bad trip. “The first time I was in this chair I was pretty nervous,” he says. “I certainly didn’t know what to expect.” As a low dosage of ketamine entered his bloodstream through the IV, he reclined back in the leather chair and his anxiety began to fade away.

When used correctly, ketamine is a cheap and effective pain killer. When abused, it can send users into what’s known as a K-hole, an out-of-body experience that’s been described as a kind of mental paralysis. But growing evidence shows that low doses given intravenously may be life-changing for patients with treatment-resistant depression. And dozens of clinics across the nation have embraced this new strategy in the fight against depression, as also reported in Los Angeles Magazine.

At the Ketamine Clinics of Los Angeles, anesthesiologist Steven Mandel has given more than 4,000 infusions over the past four years. “The other antidepressants take weeks to months to have an effect. Ketamine kicks in within hours,” he says. “It works on people that nothing else has worked on.” According to the National Institutes of Health, up to a third of those suffering from depression don’t respond to prescription antidepressants like selective serotonin reuptake inhibitors—and people like Spencer, desperate for new options, are seeking out ketamine clinics.

The infusions last 50 to 55 minutes and cause mild hallucinations. But it doesn’t come close to the intensity of the dreaded K-hole. “I don’t think anybody should be afraid of it, Spencer says. “You’re not getting handed pills at a club by somebody. You’re going to a professional and you’re in a space that’s safe.” Mandel monitors his patients throughout the procedure and adjusts the dosage accordingly. “After about five minutes you’re blasting off,” Spencer says. “When you get to the deepest part of it you feel ultimate peace.”

While Spencer says the treatment has been life-changing for him, it doesn’t come cheap. At the Ketamine Clinics of Los Angeles, infusions cost anywhere from $600 to $750 a pop. That’s unaffordable for many patients—so Mandel’s clinic mostly ends up serving professionals from the Los Angeles tech community known as “Silicon Beach.”

Spencer is the cofounder of a successful startup and he’s well aware of his advantages. “Objectively I know that I have a lot to be grateful for, and it seems like somebody looking at my life from the outside would think, ‘What does that guy have to be depressed about?’ but it doesn’t work like that,” Spencer says. “You have to look at your brain almost like an operating system, and if that system crashes it doesn’t matter if you have all the comforts of life. You’re still miserable.”

He isn’t alone. According to a 2015 study, entrepreneurs are twice as likely to suffer from depression. That may be due to a combination of work-related stress and higher rates of diagnosis thanks to better health care access. And it’s often a taboo subject in competitive industries like tech. “If you’re admitting to maybe having anxiety or being depressed, you’re giving the impression that you’re weak,” Spencer says.

Doctors still don’t fully understand how depression works, which makes studying and developing new treatments all the more challenging. “We don’t know how any of these meds work on the brain,” says Mandel. “We know about as much about ketamine as we do about any of the others. We do know that ketamine tends to cause new growth in the brain.”

While the medical community is still waiting on the results from the first large scale clinical trials, proponents like Mandel are already convinced that the ketamine therapy works on patients with severe depression and suicidality. Out of more than 600 patients, he says he’s seen an improvement in 83 percent of them. And a growing number of studies support claims that ketamine is an effective antidepressant.

But many doctors don’t support the treatment. “The main critique is that it’s been rolled out into clinical usage too soon. There’s so much about the drug that we don’t know in terms of how to use it, who responds to it, what the long term consequences of taking the drug might be,” says Victor Reus, a practicing psychiatrist and professor at the UCSF School of Medicine. “We need to have more, larger, well controlled trials using this drug. We need to follow people over time.”

And there are other concerns. While Ketamine as an anesthetic is FDA approved, using it for depression is not. That means many insurance carriers don’t cover it, limiting its reach to lower income communities. Then there’s the risk of long term dependency on a treatment that some worry may prove to be addictive. “Ketamine is theoretically addictive based on what we see in individuals who are using ketamine recreationally and in street usage,” Reus says.

But talk to patients like Sean Spencer and the concerns melt away. “I hope in the future that it’s more accessible,” Spencer says. “I know people who have been on the brink of suicide and done it and it’s 180 changed their lives.”

In Australia research and Trials are being  conducted at the University of NSW.  Hack FM wrote an article by By Ange McCormack published by the ABC.

As said in the America research in Australia it’s used as a party drug, a horse tranquilizer and an anaesthetic but could ketamine become Australia’s newest weapon against depression? According to lead researcher at the University of New South Wales, Professor Colleen Loo, ketamine could soon become a “revolutionary” treatment for depression in Australia.

Professor Loo will begin the world’s largest university-based trial of its kind in NSW this week. Two-hundred patients across Australia and New Zealand who haven’t responded to existing treatments for depression will be injected with ketamine twice a week, for four weeks. Researches will then compare the results to patients given a placebo.

While there’s already been promising evidence of ketamine’s short term effectiveness in treating depression, UNSW researchers hope they’ll be able to discover more about the drug’s long-term benefits.

“It’s an amazing drug, the short term effects that I’ve seen are remarkable,” Professor Colleen Loo told Hack. “What we need to do now is in research develop that so that we get long term benefits. And that’s what we and other people around the world are working on. It has the potential to be a revolutionary treatment for depression.”

Isn’t ketamine illegal?

Not exactly. In Australia, ketamine can actually be legally prescribed by doctors. Other uses – possessing, manufacturing, selling or driving under the influence of ketamine is illegal.

The Therapeutic Goods Administration has guidelines on what ketamine should be used for; depression isn’t one of them. But that hasn’t stopped some doctors from prescribing ketamine to their patients as a treatment for depression, Professor Loo says.

Again, it’s not illegal, and Professor Loo doesn’t say it’s necessarily “unethical” for doctors to do so. But she says it’s “incautious” to prescribe ketamine for depression before research shows how the drug should be used in that context.

There’s currently commercial clinics in Australia who administer ketamine to patients as a treatment for depression, Professor Loo says, but the jury is still out on how the drug should be used responsibly in treatment.

Last year, the ABC revealed commercial clinics in Sydney and Melbourne, known as the Aura Medical Corporation, were giving patients vials of ketamine to inject at home to treat depression.

The clinics were then forced to close down due to bad publicity, while the Australian Health Practitioners Regulation Agency conducted an investigation into the chain.

Patients were given ketamine syringes

Around 25 patients a week were given ketamine syringes to take home from the Melbourne Aura Medical clinic, May 29, 2015.

ABC: Elise Worthington

Some patients at the Aura clinic had praised their use of ketamine as a “miracle cure” for depression.

Have you used ketamine to treat depression? We want to hear from you. Email hack@abc.net.au, all conversations confidential.

“I’ve heard from patients and clinicians saying this is fantastic, let’s start giving people a series of treatments. Then they get stuck in a really bad spot.

“Then they get to the point where they start increasing the dose, increasing the frequency, and the person is gradually declining.

“Then there’s the anxiety that if you stop the treatments [the patient] will crash and get even worse than where they started. That’s kind of the nightmare situation.

“We need to work out if we’re going to use it repeatedly and what is a responsible and useful treatment protocol, rather than just giving people many treatments.”

Do patients in the trials just want free highs? Patients seeking to score some free K would be coming to the wrong place if they sign up to UNSW’s trial, Professor Loo says. First off, administering the drug in the trial is different; it’s highly controlled, and it’s not like it’s happening at a rave.

“People say to me, ‘oh do you get people who put up their hands because it’s a recreational drug and they’re coming for the buzz?’ Ketamine can cause some weird out of body experiences, but they only last for a short amount of time, half an hour or so.

“We’ve found in our study that nobody likes those effects. In fact, they say to me, ‘I don’t know how people use this recreationally!’ They’re certainly not coming for that out of body experience.”

So it’s great to read that there are clinical trials happening around the world to offer treatment resistant depression an alternative to standardised treatments. Never give up hope.

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