Ketamine, notorious club drug, shows promise as a treatment for depression, studies indicate

April 20, 2018 by John Keilman, Chicago Tribune

Sabrina Misra suffered from depression for most of her life, but last summer, it became almost too heavy to bear.

Despite years of therapy and many medications, Misra, 36, had become so despondent that she started planning her suicide. But then her psychiatrist introduced her to a new treatment with an unusual back story.

The treatment was ketamine, an anesthetic used to sedate both people and animals before surgery. It's also a notorious street drug, abused by clubgoers seeking a trancelike, hallucinatory high.

But in recent years, numerous studies have found that ketamine can be an effective and speedy treatment for people with depression—particularly those who, like Misra, have found little relief from other medications.

"After the first couple of treatments it didn't seem to work, but after I hit my fourth one, everything started to change," said Misra, a therapist and college instructor who lives in Lisle, Ill. "I went from actively wanting to kill myself to being fine."

Though some researchers have found that ketamine can be a valuable antidepressant, no one has performed the large-scale clinical trials necessary to get U.S. Food and Drug Administration approval to use it a psychiatric medication.

Consequently, most insurance plans won't pay for it, leaving patients to pay thousands of dollars out of pocket for a series of intravenous infusions.

Some warn that questions remain about ketamine's long-term safety and effectiveness. Dr. James Murrough, a psychiatrist at the Icahn School of Medicine at Mount Sinai in New York, said people who misuse the drug have developed cognitive problems, and high doses have proved toxic in rats.

And because ketamine has a history of abuse, he said, doctors and patients must consider the threat of addiction.

"We think the risk is low, but it's probably not zero, particularly if it gets scaled up," he said. "There's excitement but also a justified caution."

Nonetheless, demand for the drug is so great that dozens of specialty clinics are popping up around the country. The doctors who run them say ketamine has helped most of their patients.

"It's much better than anything we've had before," said Dr. Abid Nazeer, the psychiatrist who treated Misra at his Oak Brook clinic, Advanced Psychiatric Solutions. "I've seen it work so quickly that one infusion gets rid of suicidal thoughts that had been there for 20 years."

Ketamine was created as an anesthetic, and doctors including veterinarians and battlefield medics embraced it for its fast-acting properties and relative safety. But because it produces strong out-of-body sensations in high doses, it became a club drug, potent enough to send hundreds of people to emergency rooms each year.

In the 1990s, researchers discovered another use for ketamine: A small dose, they found, limits the concentration of a neurotransmitter called glutamate in the brain, and with startling speed, lifts the mood of many depression sufferers who haven't been helped by medications like Prozac or Lexapro.

"Our standard antidepressants can take six to eight weeks to be effective—ketamine can take just one hour," said Dr. Carlos Zarate of the National Institute of Mental Health, whose studies in the 2000s accelerated interest in the drug.

Over the past few years, doctors have opened specialty clinics that offer ketamine to patients who have depression or, to a lesser extent, chronic pain. Though the FDA has not approved those uses, the agency allows doctors to dispense drugs for "off-label" purposes if they believe it is medically appropriate.

The basic regimen calls for the intravenous infusion of a small dose—0.5 mg per kilogram of body weight, far less than someone would use to get high—six times over two weeks. After that, patients return every few weeks or months for booster doses.

Clinic operators say they screen clients to focus on those who have not improved with standard antidepressants.

"This is a last resort for those that are treatment-resistant," said Dr. June Lee of Lombard's Optimum Ketamine Center. "Most of the patients we've seen here have tried everything."

Zarate said research has shown ketamine to be effective for about 60 percent of people with treatment-resistant depression, though some local clinics say their results have been better.

"We've had about a 70 percent response rate, but it really works for them," said Dr. Vikas Patel, an emergency room physician who runs the Midwest Ketamine Center in Arlington Heights. "For the 30 percent it doesn't work for, there's no benefit at all. I would say there isn't a big in-between."

He charges $500 per infusion. Insurance typically won't cover ketamine treatments, though Patel said he expects that to change. A pharmaceutical company is seeking FDA approval for a nasal spray, he said, and other companies are testing their own versions.

But for now, the out-of-pocket cost limits the number of people who can afford the treatment. Misra said that while she put the infusions on her credit card, seeing them as a life-or-death investment, others aren't so fortunate.

"I have patients who are struggling right now, and they actually can't swing it," she said. "I think that's a horrible thing. No one should have to die because they can't pay for treatment."

Dominic Sisti, who directs the Scattergood Program for Applied Ethics of Behavioral Health Care at the University of Pennsylvania, co-wrote a paper three years ago warning about the possible risks of using for depression.

The research that has come out since then has persuaded him that it is appropriate for many people, he said, but he still believes doctors should share data on their results to further knowledge of the drug and improve the protocols for using it.

"In a sense, each patient they treat is an experiment of one," he said. "It would be really helpful if all these clinics got together and figured out a way to report those outcomes. Without those data, I worry that someone's going to get hurt."

Explore further: Antidepressant response within hours? Experts weigh evidence on ketamine as fast-acting treatment for depression

Related Stories

Antidepressant response within hours? Experts weigh evidence on ketamine as fast-acting treatment for depression

February 22, 2018
Recent studies suggest that ketamine, a widely used anesthetic agent, could offer a wholly new approach to treating severe depression—producing an antidepressant response in hours rather than weeks. Two reviews of recent ...

Suicidal thoughts rapidly reduced with ketamine, finds study

December 14, 2017
Ketamine was significantly more effective than a commonly used sedative in reducing suicidal thoughts in depressed patients, according to researchers at Columbia University Medical Center (CUMC). They also found that ketamine's ...

Study shows fast-acting benefits of ketamine for depression and suicidality

April 16, 2018
A nasal spray formulation of ketamine shows promise in the rapid treatment of symptoms of major depression and suicidal thoughts, according to a new study published online today in The American Journal of Psychiatry (AJP).

Ketamine works for female rats, too

February 26, 2018
A first of its kind study in female rats finds that a single, low dose of ketamine promotes resilience to future adverse events as it does in male rats. Published in eNeuro, the research addresses a critical gap in understanding ...

Ketamine eases severe depression, but questions of dosage, duration remain

March 2, 2017
Recent studies have confirmed observations made by Yale clinicians decades ago—the anesthetic ketamine provides rapid and robust relief to those suffering from the most severe forms of depression. However, there is also ...

Study casts doubt on ketamine nasal sprays for depression

March 16, 2018
Researchers from the Black Dog Institute and UNSW Sydney have questioned the efficacy and safety of intranasal ketamine for depression, with their pilot trial stopped early due to poor side effects in patients.

Recommended for you

How bullying affects the brain

December 12, 2018
New research from King's College London identifies a possible mechanism that shows how bullying may influence the structure of the adolescent brain, suggesting the effects of constantly being bullied are more than just psychological.

What social stress in monkeys can tell us about human health

December 11, 2018
Research in recent years has linked a person's physical or social environment to their well-being. Stress wears down the body and compromises the immune system, leaving a person more vulnerable to illnesses and other conditions. ...

The richer the reward, the faster you'll likely move to reach it, study shows

December 11, 2018
If you are wondering how long you personally are willing to stand in line to buy that hot new holiday gift, scientists at Johns Hopkins Medicine say the answer may be found in the biological rules governing how animals typically ...

Trying to get people to agree? Skip the French restaurant and go out for Chinese food

December 11, 2018
Here's a new negotiating tactic: enjoy a family-style meal with your counterpart before making your opening bid.

Using neurofeedback to prevent PTSD in soldiers

December 11, 2018
A team of researchers from Israel, the U.S. and the U.K. has found that using neurofeedback could prevent soldiers from experiencing PTSD after engaging in emotionally difficult situations. In their paper published in the ...

You make decisions quicker and based on less information than you think

December 11, 2018
We live in an age of information. In theory, we can learn everything about anyone or anything at the touch of a button. All this information should allow us to make super-informed, data-driven decisions all the time.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.