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KETAMINE & DEPRESSION Treatment Update: Paradise or Another Cruel Joke

ketamine for depression

Ketamine continues to receive big attention as a depression treatment. And why not? Many who have used it consider it a miracle drug. But, really, the tale is far from fully told. So will ketamine bring us paradise or is it just another cruel joke? Let’s stay current…

‘Despite growing interest in ketamine as an antidepressant, and some preliminary findings suggesting its rapid-acting efficacy, to date this has not been effectively explored over the long term and after repeated dosing.’  Professor Colleen Loo

Two weeks ago, George commented on a Chipur article posted three years back, “Major Depressive Disorder & Ketamine | Fanning the Flame of Hope.” He wrote, “So it’s been three years. Have there been no further developments on the efficacy of HNK?”

HNK (hydroxynorketamine or 6-hydroxynorketamine) is a metabolite of ketamine. Actually, it’s 1,000 times more potent, doesn’t act as an anesthetic, and can be taken orally. Interestingly enough, group buys are being organized online, as there are chemical companies willing to synthesize it.

I had to tell George that in spite of interest in HNK continuing to run high, it’s still being tested for efficacy and safety in humans – I believe by the National Institute of Mental Health.

I might add, a decent number of physicians are administering “off-label” ketamine infusions right now. For much more, take a peek at “Ketamine for Depression: 10 Essential ‘Infusion-Confusion’ Busters.”

The Ketamine Trial Is On

Ketamine treatment for depressionThe largest randomized control trial addressing ketamine’s potential in the treatment of major depressive disorder began a year ago in Australia and New Zealand. It’s a three year project, being conducted by researchers from the University of New South Wales Sydney, the Black Dog Institute, and the University of Otago.

The research team examined five years of published research pertaining to ketamine treatment for major depressive disorder. And they’ve discovered little reporting on the safety of repeated doses or sustained use.

According to study co-author Professor Colleen Loo…

Despite growing interest in ketamine as an antidepressant, and some preliminary findings suggesting its rapid-acting efficacy, to date this has not been effectively explored over the long term and after repeated dosing.

As ketamine treatment will likely involve multiple and repeated doses over an extended time period, it is crucial to determine whether the potential side effects outweigh the benefits to ensure it is safe for this purpose.

Late last month, the team checked-in with some important information. Seems despite the presence of acute side effects after even one ketamine treatment, monitoring and reporting wasn’t 100%. The side effects included headache, dissociation, elevated blood pressure, and blurred vision.

The study team tells us even more…

Despite low ketamine doses currently being used in depression studies, urological toxicity, liver function abnormalities, negative cognitive effects and risk of dependency may limit the safe use of ketamine as a long-term antidepressant treatment.

Professor Loo chimes in…

Our study also raises questions over the risk of administering ketamine in patients with pre-existing or co-morbid medical conditions, such as those with a history of high blood pressure or heart disease. For instance, we know that when used to treat chronic pain, ketamine is associated with acute blood pressure changes, and experts recommend lower doses administered through slower-acting, non-intravenous means accordingly.

Given these concerns, the team are in the process of developing tools to standardize future reporting on side effects – Ketamine Side Effect Tool (K-SET) – and to address inconsistencies in the literature – Ketamine Safety Screening Tool (KSST).

Okay, lots of heads-up’s for sure. But sometime take a look at the side effects of the atypical antipsychotic, clozapine (Clozaril). Granted, it’s most often prescribed when everything else doesn’t work. But that’s the intent with ketamine.

Ketamine, Depression, and the Elderly

As part of their research work, the team is actually testing ketamine’s effects, administering twice-weekly treatments to 200 participants over a four-week period.

Of the 200 participants, 16 were over the age of 60. Included in this group were individuals who had suffered from depression for years, and for whom all other treatment options – meds, psychotherapy, etc. – had failed. These participants were administered low-dose injections of ketamine.

Professor Loo?

What we noticed was that ketamine worked incredibly quickly and incredibly effectively. After a single injection of ketamine they could be completely well in a day.

Just What Are We to Make of Ketamine (thus far)?

Certainly there’s much to learn about the use of ketamine for the treatment of depression. But just as certain is the fast and powerful relief reported by many.

And I’m all the more ketamine-interested and hopeful because it works on the neurotransmitter glutamate (specifically NMDA receptors), our most abundant excitatory neurotransmitter. Yes, I’m excited that the attention shifts away from serotonin as the key to relief for depression – at least for now.

And let’s keep in mind ketamine-related chemicals and drugs like HNK, mentioned above, and rapastinel.

Speaking of rapastinel, it’s a powerful antidepressant, at one time known by the code name GLYX-13. It holds so much relief potential that the FDA granted it breakthrough therapy status, and later, fast track. It’s currently in Phase 3 (of 4) clinical trials. To learn more, eyeball “‘I Feel Depressed! So, What’s in the Relief Pipeline?’ Let’s Chat GLYX-13.”

In closing, it’s my hope ketamine and related chemicals and drugs continue to receive the attention they deserve. I mean, let’s have the tale fully told. Only then will we know if it brings us to paradise or it’s just another cruel joke.

One final thought. I more than understand the often deep downside of side effects. But if one is horribly suffering, isn’t it their right to do the benefits/side effects weighing and make their own use decision? Hmmm…

Thank you sciencedaily.com, blackdoginstitute.org.au, University of New South Wales Sydney.

More Chipur mood and anxiety disorder articles? Check-out the titles!

  • Mike

    Over 2 yrs of weekly dr visits and 30 drugs failed i was told I couldn’t be helped. I had mdd, panic attacks, s.ideation. I obtained a rx for ketamine , and after 2 weeks of use I regained emotional control, s thoughts were gone, and no more panic attacks. All this was achieved with a $100 bottle that contained 600 sprays. Starting out I used it daily, then weekly, and now only 2 sprays once a month. It isn’t without risk, but I was able to get my life back. I had hoped the nmda drugs would have been approved by now. Thanks Bill for the article, research info on the K molecule has quited down it seems over the last year :)

    • Hey, Mike…

      What an amazing tale, and it’s great having such valuable info available to all. Your statement, “It isn’t without risk, but I was able to get my life back,” says it all. It’s as though so many really don’t understand the depth of the suffering. Yes, it was up to you to do the side effects/benefits weighing and make the call.

      Would it be pushing it to inquire as to how you secured the rx? Also, in what country do you live?

      So glad you stopped-by and contributed, Mike.

      Thank you…
      Bill

      PS Let’s hold-out hope for the NMDA meds to come sooner, rather than later.

      • Mike

        here’s the info; 1st I did 1 shot from a local dr,@ $600. not covered by insurance, and it was to much k at one time. just short of unconscious, and immobile for 2 hrs. anxiety and panic next day, then some reduction in depression for the week follwing. I’m in Texas , and a neurologist in California takes out of state patients. the cost was 1400. for 3 appts 1 hr each over a week. She was very thorough and firm, and also test for drug use, even ketamine use. Every thing covered by insurance. Nancy sajben. Website is painsandiego. I had depression since childhood, and always responded to treatment Until 52 yrs old. I also was given ldn for depression and neural inflammation by her. She is board certified in neurology, with degree in psychiatry

      • Thank you, Mike. I can open the door with an article and provide information. But it’s comments like yours that really bring the story home for anyone who stops-by.

        Readers, Mike mentions “LDN for depression and neural inflammation.” LDN: low-dose naltrexone https://www.ldnresearchtrust.org/what-is-ldn

        Bill

  • trudyhibler

    This article led me to do more research on ketamine, which I first heard about several years ago. At that time, ketamine was primarily being used off label for people showing up at ERs with deep depression and suicidal ideation. I have bipolar two with a major emphasis on depression. Hypomania is a rare “treat”. Anyway, I was eventually led to articles on ketamine for the treatment of neuropathic pain. My husband suffers tremendously with neuropathy and, if it works for him, would be an answer to prayer. I found a medical center a couple of hours away in St. Louis that is doing ketamine infusions and we’re in the process of setting up a treatment plan. It’s not cheap, but if it helps at all would be worth it. Plus, the pain exacerbates an underlying depression. Treating the depression, too, would be marvelous. And you never know, the pain may not “feel” so bad if the depression is lifted. Thanks for this article.

    • Hey, trudyhibler…

      Thank you for visiting and sharing. Really helps those who check-out the piece in the days ahead. BTW, I like your description of hypomania. I’ve never had the pleasure, so I’ll just have to take your word for it.

      So the ketamine thing. How ’bout it?! Interesting angle – infusions for neuropathic pain. Given my work is with the mood and anxiety disorders, that got past me. Good to know. Sure makes sense that infusions could be a two-for-one special for your husband. And, no doubt, it’s a “reciprocating exacerbation” relationship – the pain and depression.

      FYI. Johnson & Johnson’s Janssen Pharmaceuticals is moving ahead with securing FDA approval for esketamine for the treatment of depression. Seems they obtained the rights for a use patent on intranasal delivery. Apparently it’s been approved in Europe for quite a few years for use as an anesthetic. I believe it’s somewhere in phase 3 clinical trials. Janssen was awarded its second “breakthrough therapy” designation for esketamine last year.

      Again, I appreciate your visit and participation, trudyhibler. Best to you and your husband. Keep us posted, k?

      Bill

      • trudyhibler

        Will do! Thanks for your work. And, yes, hypomania can be a treat. It has some serious pitfalls, but my meds keep it from spiraling out of control. It’s just nice to take a breather from the depression, as I’m sure you can understand. Gonna have to look for more of your articles, particularly those referencing anxiety. We have an adult son suffering from acute anxiety and any new info/treatments/plans of action are appreciated.

      • Would you mind sharing your meds regimen? Again, the info may be helpful to those who stop-by down the road. Totally your call.

        Sorry your son is struggling with anxiety, much less acute. Man oh man, have I been there. But your son’s situation doesn’t surprise you and your husband – or him – right? I mean, the both of you are managing your own emotional/mental health circumstances.

        Tell me, what does your son’s “acute anxiety” look like? Diagnoses? Meds? Again, my curiosity and desire to help are causing me to push the boundary envelope. So again, totally your call.

        This is a great exchange, trudyhibler. Thank you for your openness…
        Bill

      • trudyhibler

        I opened up on facebook a few years back about the challenges I face and was overwhelmed with the support. Nothing negative, just support. I since worked with probably a dozen people either suicidal or near that, just listening and encouraging them to GET HELP!!! One, who first reached out for advice on how to help her daughter, has finally opened up to me about her own difficulties. I’m not a therapist or a doctor, but I can “listen” and chat. I figure if my own story can help even one person, then being open is worth it. So…me. I’m on 40mg Viibryd…definitely helps with both the depression and anxiety. While I still have anxiety issues to a point, I can at least climb a ladder now all the way to the top and have photographed Hoover Dam looking straight down. Formerly, I was very afraid of heights. So, I love it. Let’s see…Cymbalta 60mg 2xdaily, Lithium 300mg daily, and Abilify 20mg at night. Those are just my psych meds. There’s a story behind the Lithium…but it’s rather lengthy so I’ll leave it for another time. I know my son’s anxiety involves racing thoughts, pounding heart, a lack of desire to do anything because it’s just too hard. Then that feeling itself makes him anxious. He was placed on Effexor a month or so ago and that seems to have helped the depression. He’s become more sociable with us here at home. He wasn’t antisocial before, just spent more time in his room. I’ll see if I can get him to open up about his meds. He’s been a bit reluctant to share some of that info and we don’t press. I do believe he was diagnosed at one point with borderline personality disorder, but I could be wrong. Geez. Get me talking about this stuff and I never know when to shut up! Sorry for the lengthy post.

      • Very glad to have your “lengthy post,” trudyhibler. I mean, this is what makes Chipur so powerful. I can kickoff the discussion with an article and provide value. But when readers chime-in, the value exponentially increases.

        I’m so impressed by your giving back. As I’m sure you know, many just wouldn’t do it, for any number of reasons. I can tell you that the spirit of giving back/helping others is what got me to head back to grad school and get my counseling credentials very late in life. It’s just one of those things, right? When you’ve hurt so badly without hope, and somehow emerged, your heart goes out to those struggling in a similar manner.

        I’ve enjoyed this exchange so much. Thank you for your participation, trudyhibler…

        Bill

      • trudyhibler

        You’re welcome! I would love to get back in school and pursue a degree in therapy. That’s one area where I feel “broken” though. I always aced courses without trying. It was the one thing that came easily to me. Now…well, I almost had a nervous breakdown trying to take a course required for me to complete work on my bachelor’s degree. I’m one semester short. Dang. Sigh. Oh, well! Life goes on, and I’m blessed to have a good life. Thank you!

      • You’re welcome, th. And thank you!

      • Hey, trudyhibler…
        Hopefully you’re following the comment thread. Wondering if you’d consider writing a guest post for Chipur re your experiences. You can reply here or contact me through link at the top of page.
        Ty!
        Bill

      • trudyhibler

        I’d be happy to! I do like to “talk”. LOL!! And I’m very open to sharing my own experiences. It may be a couple of months. We just sold our house (two days ago!) and with the nearest ketamine clinic (for lack of a better term) being 2 1/2 hours away, I just can’t afford to take that many days away from packing, etc. But, yeah, I’ll be happy to share once I’ve completed treatment.

      • You just chime-in when you can…