Ketamine: The Good and The Questionable

Party drug to treat depression? Sounds far fetched, and it kind of is. Ketamine shows promise, but also raises many questions.

Ketamine (C13H17Cl2NO), is a dissociative, hallucinogenic anesthetic used for human and animal operations and pain management. Dissociative drugs cause sedation, hallucinations, and memory loss, as well as a sense of detachment from reality. Ketamine was developed in the 1960's as a replacement for PCP (phencyclidine). Both Ketamine and PCP are in a class of drugs called NMDA's (N-methyl-D-aspartate). Other NMDA's include dextromethorphan (street name; Angel) and Methoxetamine (MXE). NMDA's are widely used as street and date rape drugs.

So, how can ketamine be used to treat depression?

Well, scientists are not completely sure how it works, but there is a decent amount of evidence showing it does.

In the 2013, a randomized controlled trial was done to study the effects of ketamine on treatment-resistant depression. The RCT, which included 73 participants who suffered from depression, in which traditional treatments had little or no effect, found that ketamine was able to relieve symptoms of depression where other anti-depressants failed. Ketamine also started working very quickly, in as little as four hours compared to the multiple weeks traditional anti-depressants take to kick in. the effects also lasted for weeks after the fact.

Scientists are not sure how ketamine works. However, it is thought that is works by rebuilding connections between brain cells by way of synaptogenesis. Those with depression tend to have less connections between their brain cells. The idea is that with more connections between cells, the brain will experience less depressive symptoms.

Although ketamine sounds like a great treatment, even for those without treatment resistant depression, it is still in some very early stages. Ketamine was approved by the FDA, however, that approval comes with some restrictions. It must be administered in a physicians office, patients will be monitored for multiple hours afterwards, and patients should not drive while under the drugs effects. Doctors and researchers are understandably concerned about the drug, since there are only a handful of studies, and none of them look at long-term effects. There is also possibility for abuse, since ketamine is already a party drug. However, that is where the restrictions to the doctors office come in.

It is important to remember that ketamine has not been tested on many people, and those it has been tested on have extreme or treatment resistant depression. This drug is not yet approved for, or has been studied in those with mild, moderate, or severe chronic depression. Much more research is needed to find out if ketamine can be used as a safe, effective, and long-term solution to those with treatment resistant depression.

Citations

Ketamine. https://www.drugbank.ca/drugs/DB01221. Accessed 1 May 2019. “Ketamine: Risks, Warning Signs & What Parents Should Know.” Where Families Find Answers on Substance Use | Partnership for Drug-Free Kids, https://drugfree.org/drug/ketamine/. Accessed 1 May 2019. Sanders, Laura. “A New Ketamine-Based Antidepressant Raises Hope — and Questions.” Science News, 5 Apr. 2019, https://www.sciencenews.org/article/new-ketamine-based-antidepressant-raises-hope-questions. SciShow. Ketamine Gets Controversial FDA Approval for Depression Treatment | SciShow News. YouTube, https://www.youtube.com/watch?v=Nx6pb73jBTg. Accessed 5 May 2019. SciShow Psych. 3 Baffling Depression Treatments and Why They Might Work. YouTube, https://www.youtube.com/watch?v=akWAc3ju_Hg. Accessed 5 May 2019. The Buyers - Pharmacology | Drug Wars | FRONTLINE | PBS. https://www.pbs.org/wgbh/pages/frontline/shows/drugs/buyers/pharmacology/pcp.html. Accessed 1 May 2019.