Is Ketamine a potential lifesaver or could its roll-out for prescription use spark an opioid style crisis?
“Legs buckling and eyes rolling, mare Lulu slumps against the wall of the veterinary operating theatre,” reads a column in the Sun, warning against the use of ketamine. “She lies dead-eyed — spread out and helpless, her tongue lolling and her breathing heavy and laboured. Totally under.”
Ketamine, a licensed anaesthetic that is used globally in emergency rooms and veterinary surgeries, is gearing up for designation as a breakthrough drug for the treatment of depression, casting away the equine-tarred house party stereotypes of the past.
A recent study published in the American Journal of Psychiatry found that administering a small dose of ketamine via a nasal spray significantly ameliorated depressive symptoms within a day.
“These findings may reflect a promising breakthrough in the clinical management of a potentially lethal condition for which there are no approved pharmacotherapies,” the authors wrote, of the first drug company funded investigation into ketamine’s efficacy as a depression treatment tool.
Crucially, ketamine could also be used to rapidly reduce suicidal thoughts in individuals experiencing a serious depressive crisis, thanks to its fast-acting properties. Existing antidepressants can take four to six weeks to take effect.
“It does suggest ketamine treatment can help someone who’s in a really serious suicidal state get out of that quickly,” said study author Michael Grunebaum, an associate professor of psychiatry at Columbia University Medical Center. “Certainly, it would be a relatively simple treatment to provide at hospitals.”
A woman in Lisle, Illinois, US, told the Chicago Tribune that her depression, which had resisted the traditional types of treatment, had brought her to the brink of suicide until her doctor prescribed her ketamine.
“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. “I went from actively wanting to kill myself to being fine.”
Her psychiatrist echoed her remarks on the transformative effective of the rapid-action drug. “It’s much better than anything we’ve had before,” said Dr. Abid Nazeer. “I’ve seen it work so quickly that one infusion gets rid of suicidal thoughts that had been there for 20 years.”
With the female suicide rate at its highest ever level in the UK at the moment, this could be a welcome alternative to electroconvulsive treatment.
The procedure involves sending an electric current through the brain to trigger an epileptic seizure and is used to relieve the symptoms of people with severe, life-threatening depression who are among the 55% of patients who do not respond to traditional antidepressants.
It can cause significant, long-lasting and disabling memory loss, and no one is sure how exactly it works, although a majority of people say it improved their symptoms.
However, ketamine does not eliminate depression and experts are also mindful of the possible consequences of providing a potentially addictive drug to millions of people.
“The history of pharmacology includes many life-saving drugs. However, it is also replete with examples of drugs whose abuse has outweighed their intended therapeutic effect,” the journal’s editorial board wrote.
“The most recent example is oxycodone, which was developed as an alternative to older abused opioids and then heavily promoted to protect patients from pain after medical and dental procedures.”
Increased access to oxycodone in the late 1990’s, and the downplaying of the drugs’ addictiveness by its manufacturers, was the catalyst for the opioid crisis which still blights countless communities across the US.
Although none of the study’s participants developed an addiction to the class B drug, it is feared that its increased availability and the possibility of people forming dependencies, could lead to a similar crisis.
Others are also afraid that the upward trend of people using the drug, which is banned for recreational use, will rise. This is why experts and healthcare professionals are calling for the establishment of a national registry to monitor its use under full licensing.
Ketamine has already been prescribed off-label in the UK, and users attest to the transformative effect it has had on their lives, with some claiming ketamine helps them manage their thoughts.
With the Royal College of Psychiatrists saying the study brings the drug “a step closer to being prescribed on the NHS”, that floating and detached feeling continues its march from dancefloors and stables to the mainstream.