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Ketamine for depression divides experts: ‘I’ve seen these drugs come and go’

Ketamine for depression divides experts: ‘I’ve seen these drugs come and go’
Health
Depression can be completely debilitating, making it difficult to do even the simplest tasks — like getting out of bed or brushing one’s teeth.

Unfortunately, it’s very common. According to the World Health Organization , more than 300 million people around the world are currently suffering from depression.

Now, there may be a new way to treat the illness: ketamine.

Ketamine is commonly used as an anesthetic and painkiller in animal and human surgery. It also rose to popularity as a party drug in the 1990s. Now, it’s being lauded as a possible cure for treatment-resistant depression.

“We have a large sub population in our country with depression who can’t work… they just can’t break this vicious cycle,” said Dr. Roger McIntyre, president of the (CRTCE).

McIntyre hopes ketamine can break that cycle.

The CRTCE, which administers rapid onset treatments for depression in the form of ketamine injections, is the first of its kind in Canada.

At the CRTCE, ketamine is delivered through intravenous infusion. According to the clinic’s website, “the protocol for administering ketamine is still being refined. Nonetheless… most individuals will receive four infusions (i.e. two infusions per week for two weeks).”

The cost of this treatment at the CRTCE is $3,000, and it is not paid for by the public health plan of Ontario (OHIP).

The process is overseen by a physician trained in anesthesia, as well as a nurse.

“The dose of ketamine by someone on the street… is about 10 times higher than the dose [you would be given] if you went to the hospital this afternoon for a procedure that required anesthesia,” said McIntyre. “The dose that we use to treat depression is about one-10th… of the dose used in anesthesia. So we’re using ‘sub-anesthetic doses.”

According to McIntyre, this does not mean the process is without safety concerns.

“[We] know it’s generally well received by patients, but it would be inaccurate to say that you don’t get any side effects,” said McIntyre. 

According to (CAMH), ketamine can produce “vivid dreams and a feeling that the mind is separated from the body.” This effect is known as “dissociation.”

The intensity of the effects depend on several factors, including: your age, your body weight, how much you take, how often you take it, how you take the drug and more.

“Some people do become addicted, and continue to use ketamine even when they plan not to or despite its negative effects,” as stated on the CAMH website.

If a patient presents with intense suicidal thoughts, ketamine may be a more effective short-term treatment than other antidepressant medication.

“Most antidepressants take approximately four, six or even eight weeks to work. That’s a long time,” said McIntyre. “If you’re suffering, ketamine can work within one day.”

Dr. David Gratzer, a psychiatrist at CAMH, is hopeful about the effects of ketamine on depression for this reason.

“We are looking for a way of providing more rapid relief of depression than one might ordinarily see with Prozac and [similar] drugs,” said Gratzer.

“The evidence is there but we have to take it with a grain of salt because it’s early days. That being said, we do seem to find evidence that it helps people very quickly, particularly people who have many thoughts of suicide.”

Depression is difficult to understand — even for medical professionals.

“As with most diseases in physical medicine and mental health, we have a sense of what’s involved but we don’t exactly know,” said Gratzer.

According to Gratzer, doctors do know that family history and certain traumatic life events are connected with a higher risk of depression.

“However, two people can be raised in the same household and eat the same foods and have a relatively similar childhood and one can get heart disease while the other doesn’t,” said Gratzer.

“Likewise, you can get [depression] and your sibling may not. So, while we do recognize there’s a strong genetic component… it’s not 100 per cent. There’s more going on.”

Because of the evasive nature of depression, finding a treatment that works can be difficult.

Once someone is diagnosed, they are usually prescribed one of or a combination of three kinds of treatment: exercise, talk therapy and medication. According to Gratzer, patients “do the best” when they do all three.

But, for some patients, none of these treatments work. And that’s where ketamine can be an exciting option.

“Ketamine is one of a handful of medications that is out of the box,” said Gratzer. 

To be eligible for treatment at the CRTCE, there are three criteria: you are over the age of 18, you are medically stable and you have had a minimum of two other treatments for your depression.

McIntyre admits that the full effects (positive and negative) of the drug are unknown.

An issue McIntyre and his team are paying close attention to is the impact ketamine can have on other organs, like the kidney or the bladder.

Another is whether ketamine can act as a gateway to other, more severe drug abuse, said McIntyre. 

The CRTCE website states that, “it is critical to understand that ketamine researchers are still exploring a multitude of ways that ketamine infusions impact the human brain. They are working towards understanding why this form of treatment works so quickly and effectively.”

Despite its positive impact thus far, Gratzer isn’t ready to call ketamine a “wonder drug” yet.

“I’m optimistic, but I’ve got a few gray hairs, so I’ve seen these wonder drugs come and go,” he said.

“We need to take it to the next step… can we use it on more people safely? What sort of side effects do they get? Are the effects [on depression] we see with ketamine lasting?”

Gratzer is interested to see whether the effects of ketamine can remain beyond the days after it’s injected.

“It’s great that some people might see relief… if you’ve got a pain on your left hand, it’s great that you feel better with a Tylenol. But that tends to fade and maybe what you really have is a little infection of the skin and what you should really take is antibiotics,” said Gratzer. 

“I hope this is working out because it will be helpful, but I don’t really know and I don’t want to be too optimistic. Like a lot of private healthcare, the sales pitch may not be as good as the reality.”

If you or someone you know is in crisis and needs help, resources are available. In case of an emergency, please call 911 for immediate help.

The Canadian Association for Suicide Prevention, Depression Hurts and Kids Help Phone 1-800-668-6868 all offer ways of getting help if you, or someone you know, may be suffering from mental health issues.
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