Why Not Just Use Ketamine?

One of our readers asked the question…

Ketamine is around and it works to quickly treat depression.  Why all the effort on something else that is not ketamine but like ketamine?

Bad Reputation

Part of the problem is that ketamine has gotten a bad reputation.  It was used as a “party drug” with the street name “Special K”.  “Clubbers”, people hitting the clubs on Saturday night, would use it to get high with an “out of body” experience.  One feels disconnected from reality.  Some have vivid dreams that they like.

Does Its Abuse History Matter?

It shouldn’t.  Ketamine is used appropriately in medicine and dentistry.  It’s an anesthetic and an analgesic (treats pain).  It’s a good drug that has been used in medicine for almost 50 years.  The fact that a few crazed fools misuse it should not prevent its use for a medical treatment.

So, It’s Safe

Well, it’s safe, or relatively safe, when used one time by a trained and skilled anesthesiologist in a medical setting.  Is it safe when used in a less skilled physician’s office repeatedly to keep major depression at bay?  Maybe not so much.

There Are Side Effects and Adverse Reactions

One can have dissociative symptoms as early as an hour after ketamine infusion.  Also, symptoms like psychotic hallucinations.  Yuk!  Cognitive losses, bladder toxicity, and liver toxicity have also been seen.  There’s a long list of potential problems with blood pressure swings, heart rate changes, and increased intraocular (within the eye) pressure.

2 scientists at bench

Ketamine-Like Medicines that are Better than Ketamine

This would be a reason to look for new molecules with effects similar to ketamine.  Better in that they would work better to treat depression.  Better in that they would be safer to use without the adverse effects.  One company is developing a nasal spray ketamine derivative, esketamine.  It would be a lot easier to use than an intravenous drug like ketamine itself.

Then One Can’t Ignore the Profit Motive

Not to paint pharmaceutical companies as greedy villains, but…  They are not non-profit charities.  Ketamine’s an old drug and long off patent.  It’s cheap and many companies, including companies in China and India, can make it.  A new molecule can be patented as a new medicine, a novel chemical entity, and a miracle drug price charged.

Ketamine Has Its Advocates

All of the above having been said, using ketamine has its advocates to treat depression for people where nothing else has worked.  Good physicians, bright, ethical physicians, academic physicians.  Healing doctors with little profit motive.  Some have treated depressed people with ketamine every 2 to 4 weeks for up to 3 years without a problem. Some have even proposed that it might be unethical to have a person with severe, chronic depression that has not been successfully treated with anything else and deny them a trial of ketamine.

Many “Ketamine Clinics” in the United States

Some of these physician advocates have started clinical offices that give ketamine for severe depression.  There are now many such ketamine clinics across the U.S.

Helpful links:

ClinicalTrials.gov

https://clinicaltrials.gov/ct2/results?recrs=ab&cond=Depression&term=ketamine&cntry=US&state=&city=&dist=

https://clinicaltrials.gov/ct2/results?cond=Depression&term=ketamine&cntry=US&state=&city=&dist=

National Institutes of Health, National Library of Medicine, PubChem

https://pubchem.ncbi.nlm.nih.gov/compound/ketamine

National Institutes of Health, National Library of Medicine, National Center for Biotechnology Information, PubMed Central

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3438349/

The Psychiatric Times

https://www.psychiatrictimes.com/bipolar-disorder/exploring-new-therapeutic-areas-treatment-depression-and-bipolar-disorder

The Lancet Psychiatry

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(15)00392-2/fulltext

The Mayo Clinic

https://www.mayoclinic.org/medical-professionals/psychiatry-psychology/news/ketamine-exploring-continuation-phase-treatment-for-depression/mac-20430307