Ketamine, a drug once associated with raucous parties, bright lights, and loud music, is increasingly being embraced as an alternative…
Ketamine, a drug once associated with raucous parties, bright lights, and loud music, is increasingly being embraced as an alternative depression treatment for the millions of patients who do not get better after trying traditional medications.
The latest provider of treatment is Columbia University, one of the nation’s largest academic medical centers.
Starting this month, Columbia joined a growing list of major medical centers offering ketamine infusions to patients with severe depression, for whom traditional antidepressants like Prozac or Celexa have failed.
Elsewhere in the US, patients can get ketamine at a smattering of private clinics, but not all of them are subject to the strict medical supervision that’s generally required of academic medical centers. In sommige gevallen kunnen patiënten ook de behandeling krijgen door deel te nemen aan onderzoeksstudies, maar Columbia’s move helpt de behandeling meer breed beschikbaar.
Ketamine is not cheap, and it is not quick to administer. Fordi det er givet ved en IV-drip, kan processen tage mellem 45 minutter og to timer. Each session costs $ 500 to $ 750 (Columbia is charging $ 650) and is not covered by insurance, because ketamine is only approved in the US for use as an anesthetic.
Patients given ketamine for depression are typically advised to get 8 to 1
2 sessions, bringing the total cost to as much as $ 9,000.
Despite its hefty price, ketamine has been called “the most important discovery in half a century” for mental illness. The drug seems to involve a different part of the brain than traditional antidepressants, and its apparent rapid-fire effects may be particularly useful for staunching suicidal thinking in people who are considering taking their own lives, experts say. Ketamine also has a long history of being used to prevent pain, which suggests to clinicians that it’s relatively safe.
“Ketamine is the real deal in that it is a genuine pharmacologic agent that has been used for a long time for anesthesia,” Jeffrey Lieberman, the chair of the psychiatry department at Columbia University’s Irving Medical Center and the director of the New York State Psychiatric Institute, Customs Business Insider.
And while ketamine’s applications for mental illness are relatively recent, Lieberman is hopeful that the drug will eventually be more widely available to patients in need.
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Most antidepressants, from Abilify to Zoloft, work by plugging up the places where our brain takes up serotonin, a chemical messenger that plays a key role in mood. The result is more free-floating serotonin and, in some people, relief from a dark curtain of depressive symptoms. Men så mange som en i tre patienter mislykkes i å reagere på medicinerne, og ingen ny type depression stoff har blitt oppfunnet siden da.
Those are the patients who experts say ketamine might help.
In these patients, Cristina Cusin, a psychiatrist at Massachusetts General Hospital and an associate professor at Harvard University, told Business Insider this spring. Når de smerter blir så intense at det kommer i det daglige livets aktiviteter – så kan det være så enkelt som å skrive en epost – pasienter kan føle seg fortvilet nok til å gjøre alt for å lindre lidelsen. But current antidepressants take 4-6 weeks to work.
That’s not good enough for patients who need help now, said Cusin.
Read more: A handful of clinics are embracing a ‘party drug’ that could be a rapid-fire depression treatment – we got a look inside
] Large institutions are starting to embrace ketamine therapy.
On the West Coast, the University of California in San Diego began offering the infusions to select patients with severe depression in 2010. Kaiser Permanent started administering ketamine as part of a pilot program in Northern California for people who did not respond to other medications in 2015.
On the opposite side of the country, a handful of specialty centers recently began offering the treatments. They include Emory, Yale, and Massachusetts General Hospital, which began offering the treatments this case.
Several other medical centers including the Cleveland Clinic, the Mayo Clinic, and the Icahn School of Medicine at Mount Sinai are administering the drug as part of ongoing research on ketamine and depression.
“The rapid antidepressant effects of ketamine in patients with severe, chronic, and treatment-resistant forms of this disease may represent a true medical breakthrough,” James Murrough, the director of the mood and anxiety disorders program and an associate professor of psychiatry and neuroscience at the Icahn School of Medicine, wrote in an October story for Scientific American.
Columbia University’s program is one of the first to not require patients to show a specific number of failed treatments for depression in the past. (At Kaiser, patients must show that they have tried at least three different antidepressants and failed to respond to each one.)
Still, Lieberman stressed to Business Insider that experts carefully weigh the benefits and risks before recommending treatment to a patient, and they always advise people to try traditional medications first.
“We have to do a very careful story and if [someone has] a mood disorder, what’s their treatment been? Is the person genuinely unresponsive to standard treatments?” Lieberman said.
Ketamine is believed to engage a different brain system than the one targeted by traditional antidepressants. Det ser ut til at fungere på nøkkelbrytere i hjernen, som kalles NMDA-receptorer, som påvirker mood og hjelper med å holde våre hjernes synapses – de delikate grene, der fungerer som økosystem for vores tanker – fleksibel og resilient.
Depression damages these brain switches. And while traditional drugs may help to rescue them over time using serotonin, ketamine appears to deliver its support directly to the source, plugging up NMDA receptors like a cork in a bottle and nipping depressive symptoms quickly.
A spate of recent research supports this idea of how ketamine provides relief.
Last December, researchers working with depressed and suicidal patients concluded in a study that ketamine was better at curbing suicidal thoughts than a commonly used sedative. De meeste deelnemers in de studie, gepubliceerd in de Amerikaanse Journal of Psychiatry, hebben hun moods begonnen te liften binnen 24 uur na ontvangst van de drug. In sommige mensen, die effecten duurde meer dan een maand.
Similarly, the authors of a 2012 review of four preliminary studies on ketamine in patients with severe depression expressed surprise at how rapidly the drug appeared to produce positive and accurate results.
Read more: Pharma giants are looking to ketamine for clues to the next blockbuster depression drug – and science says they are on something big
But ketamine also has several drawbacks, aside from its steep price tag.
Ketamine induces what many people refer to as a high. Dette inkluderer følelser eller dissociation fra sitt kropp, flytende, så vel som å se lyse farger og former. Noen eksperter har foreslået dette kan føre til problemer med afhængighed.
In addition, ketamine’s side effects may include blurred vision, headaches, and increased heart rate. And clinicians are not yet sure how long ketamine’s anti-depressive effects last. Selv om enkelte patienter synes at være i stand til at opleve en fuldstændig lindring af deres symptomer efter flere ugers behandling, vil andre enten ikke reagere eller kun se forbedring for flere dage eller uger.
Nevertheless, several clinics outside of established medical centers are also offering the treatments, and while some are legitimate, others are what Lieberman described as “scary” and “aggressive” in their marketing tactics.
“It’s not that ketamine should not be available – it should just be available in a legitimate and medically-controlled and rigorous setting,” Lieberman said.
Ketamine is also inspiring research into other new depression drugs that work on the brain in a similar way. Homing in on this channel lijkt te bieden relief van depressie dat beter is, komt sneller en werkt in meer mensen dan bestaande drugs.
Allergan, the multinational pharmaceutical giant known for Botox and Birth Control, has recently been deeply researching an injectable drug called Rapastinel, which works on the same brain pathway as ketamine. San Francisco-based drug company VistaGen is working on a similar drug known for now only as AV-101.
Similarly, Johnson & Johnson submitted a nasal spray formulation of ketamine called esketamine to the FDA in September for its review. New York-based biotech company Seelos Therapeutics also has a nasal form of ketamine in its pipeline called SLS-002.
But research is still early, experts say.
“We are just scratching the surface of the mechanisms of action with ketamine,” Cusin said this spring.