Can this Club Drug Really Treat Depression?
You may know of ketamine by its street name “Special K,” and you may be aware that it can produce dreamlike and hallucinogenic effects. You may also know that ketamine is approved by the U.S. Food and Drug Administration (FDA) as an anesthetic. But did you know that ketamine is now being prescribed to treat mood disorders like depression?
What can ketamine do?
Ketamine’s FDA approval for anesthesia created a unique opportunity for physicians to prescribe the drug for “off-label use” (meaning the drug can be described for alternative medical reasons – in this case, depression). FDA approval also facilitates research designed to further explore its medicinal properties. While many studies examining the use of ketamine to treat mood disorders are ongoing, published results from seven studies are promising.
A total of 147 research participants have been treated with ketamine in randomized double-blind studies, the gold-standard research design in which neither patients nor doctors know who received ketamine and who received a placebo. Results consistently indicated a strong antidepressant effect of ketamine. Those who received ketamine also experienced significant symptom relief in as few as 24 hours.
Additionally, results suggested that ketamine may help to rapidly reduce suicidal ideation among patients deemed at risk for suicide. This even holds true for those individuals who do not respond to standard treatment, which may be ketamine’s greatest promise. However, continued research is needed before ketamine can be recommended as the front-line treatment for most patients with depression.
Why is it important to try new treatments?
Standard treatments for addressing suicidal ideation that accompanies mood disorders – which include antidepressant medication, psychotherapy, electroconvulsive therapy, and hospitalization – vary in efficacy and often fall short in reducing symptoms. This is particularly troubling because suicide is the second leading cause of death in the U.S. among individuals under 44-years-old. Despite widespread efforts to prevent suicide, rates have actually increased over the past 10 years.
Given the emerging evidence suggesting that ketamine may help in the treatment of intractable depression, some doctors are adding the drug to treatment regimens. Over 3,000 patients have now been treated with ketamine by psychiatrists across the U.S. and Canada.
Where do we go from here?
Whereas some mental health professionals believe that ketamine might be a much-needed breakthrough for treatment-resistant mood disorders, caution is warranted. Ketamine is a controlled drug with abuse and addiction potential.
While results are promising, there is little data available on the long-term efficacy and safety of ketamine treatment for depression. It’s also unclear if the therapeutic benefits of ketamine outweigh the potential health risks if adopted widely and prescribed as freely as other antidepressant medications – for example, by primary care physicians with minimal training in psychiatric or substance use disorders. Until the research evidence regarding its safety and effectiveness is more solid, the case is strongest for ketamine’s use when other traditional mood disorder treatments have failed or in cases of imminent risk of suicide and when it is administered by a psychiatrist with specialized training. More quality research is needed to determine the long-term risks and benefits of ketamine and to ensure that the potential for misuse is carefully evaluated and monitored.
Nicole is a Research Assistant at Center on Addiction