— Ketamine is definitely a multipurpose anesthetic that is used to deal with kids, adults, and even dogs as well as other animals, also it’s a reputation as a popular – and illegal — club drug dubbed “Special K.”
Recently, research workers having been testing ketamine as a treatment for depression. In one of the biggest ketamine trials to date, researchers at the Michael E. Debakey VA Medical Center and Baylor College of Medicine in Houston found that 64 percent of seriously depressed patients got relief from depression symptoms within 24 hours of receiving a single dose of the drug. In some cases the relief lasted up to five weeks. For comparison, study subjects who used the anesthetic midazolam revealed a 28 percent decrease in depression.
Ketamine is famous for closing off pain receptors and also occasionally causing a dissociative state and is typically found in human and veterinary medicine. It could prompt hallucinations in some individuals, so patients with this trial were screened to exclude anyone having a history of a psychotic illness or bipolar disorder, alcohol or substance misuse in the last two years, unstable medical illnesses, serious and imminent suicidal or homicidal risk, and also other medical problems.
“Ordinarily, we viewed some sort of development within a four-hour period [with ketamine],” said lead researcher Sanjay J. Mathew, MD, a psychiatrist at the Debakey VA Centre and Associate Professor of Psychiatry & Behavioral Sciences at Baylor. “Afterward our primary consequence was looking at 24 hour outcomes, where we found about two thirds of patients with pretty badly refractory illnesses had a major result on the melancholy scales.”
73 depressed patients who all shared the common trouble of having been on three different conventional depression meds that had failed to alleviate their symptoms were contained by the trial of Mathew. The patients were studied in two distinct areas of the nation to see whether the consequences would be the same regardless of background and location. This made it not only the biggest sample group in a ketamine study but the initial time patients were analyzed in two facilities, said Mathew, who worked with researchers at the Icahn School of Medicine at Mount Sinai Medical Center in Ny.
“A huge surprise was there were subgroups of patients who remained well, depression-free, and not relapsed in the five-week observation period — and that is all off antidepressants,” Dr. Mathew added.
The Ketamine Encounter for Patients
Participants in Mathew’s study were given ketamine in an intravenous drip that lasted 40 minutes, in a restricted environment, and detected for symptoms.
Overall, 17 percent experienced the dissociative state — common with ketamine. Two patients had their ketamine infusion terminated due to significant changes in blood pressure.
“There is often a relaxation, there’s undoubtedly a feeling the weight of the world was lifted,” Mathew said. “If they’re describing depression as this huge weight that is keeping them down and preventing them from living, then there is an awareness of being discharged from that weight. So it is a very different feeling than euphoria, where individuals are laughing, or giddy or hysterical, or, frankly, manic. It’s a feeling that is very different. It’s more of a removal of something not good compared to the induction of something thrilled. Our sense about it is it is not a euphoric or happy pill, it is taking away pain.”
How Ketamine Is Typically Used
Ketamine is used to block pain and sedate children and grownups, along with animals, and is particularly popular in emergency room settings when doctors need to set a broken arm or stitch a laceration. It is not slow -acting and allows the patient to be awake but removed from pain.
A few of the other ways it is used in medicine:
- On burn wards and ICUs for dressing changes
- During labour and delivery as well as other procedures requiring anesthesia
- For continual pain
- As palliative care
- In pediatric emergencies
Ketamine in some specific doses may be similar to PCP, also known as “Angel Dust,” and have effects on the central nervous system, including causing hallucinations. That is what makes Special K a popular illegal drug that is also occasionally used as a date rape drug.
Mathew agrees that ketamine can be abused if in the incorrect hands. “Sort of like Ecstasy, it may be used in party scenarios,” he said. “We realize that the FDA considers it to have abuse liability. There is a magnitude of difference in the actual dose for people who abuse it recreationally.”
How Ketamine Relieves Depression
Researchers believe ketamine works on a system different than a typical antidepressant.
“It seems to focus on a system called the glutamate system,” said Mathew. “The glutamate system is the major neurotransmitter in the brain. It constitutes about 80 per cent of neurons, so it’s situated in multiple areas of the mind. Glutamate is very important in several mental phenomena that are different, including other aspects of cognition, mood, as well as memory. So it is a very fundamental neurotransmitter.”
“Ketamine functions by blocking the action at a certain glutamate receptor and by doing so it likely improves action in another glutamate receptor system,” he added. “By doing that it may enact a cascade of events inside the brain, in the neuron, which may be connected with neuroplasticity, the power of the brain to reshape itself or develop connections between distinct regions of the brain. So that it can be a nervous shaping process.”
Mathews pointed out it is still very early in the research, that in general the amount of patients in all ketamine studies is still relatively little. There’s also continuing research about how to provide ketamine (including an intranasal version). But he believes a conventional antidepressant is the fact that it brings immediate results — rather compared to the normal four to six weeks to more it takes for an antidepressant to work and the significant difference between ketamine.
“We’re not recommending it for routine clinical practice,” he said. “I do not believe there will ever be a perfect pharmaceutical for something as complex as melancholy where there are multiple factors at play…but what this drug does is work on a fundamentally different system then the unusual antidepressant medicines we have on the marketplace. Ketamine might be fast-tracking this procedure [to] within a couple of hours.”
PICTURE CREDIT: Voisin/phanie/Phanie Sarl/Corbis