Ketamine: Party Drug to Miracle Antidepressant
EVE SHARIFI Ketamine, more popularly known as club drug Special K, has been used since the 1960s. Its psychedelic effects include “out of body” experiences and hallucinations, and the drug is often called the “date-rape” drug. However, ketamine also has anesthetic effects and it is often used in emergency rooms and burn centers to quickly numb patients with critical injuries, especially children with broken bones or dislocated shoulders.
In 1987, FDA approved Fluoxetine as the first selective serotonin receptor inhibitor (SSRI) drug used to treat depression, panic disorder, posttraumatic stress disorder, and social anxiety disorder. It was often hailed as the miracle drug since it treated the majority of mood disorders and it didn’t have the adverse cardiovascular side effects of previously used antidepressants, such as MAOIs or TCAs. It also had a greater margin of safety since overdoses were much less likely and less dangerous. Even though the exact neurological mechanism of SSRIs is not well understood, it has been found that this class of drugs increase the synaptic levels of serotonin by limiting its reabsorption by reuptake mechanisms in the presynaptic terminal. The common SSRIs used today to treat depression and anxiety disorders include Prozac, Paxil, and Zoloft.
In terms of treatment, however, SSRIs have several significant limitations. They often take several weeks to take into effect and during this time delay patients continue to suffer from mood disorders and can have suicidal thoughts that result in them taking their own life. Additionally, several longitudinal studies have found that traditional antidepressants are only beneficial for patients with mild to moderate depression and these drugs are ineffective or have very small therapeutic effects for patients with severe depression.
Even though this area of neurobiology has been an intense subject of research over the past decade, no other effective antidepressants have been found since the discovery of Fluoxetine. It was almost by accident that researchers discovered ketamine to work as a potent and miracle antidepressant in controlled doses. A growing number of academic medical centers, including Mayo Clinic, Cleveland clinic, and Yale University have begun offering ketamine to patients with severe depression. It has been hailed as the “next big thing” in the treatment of depression since it has an almost immediate effect on patients who had been previously resistant to traditional antidepressants or who had cycled between various antidepressants and mood stabilizers for years with no significant improvement in mood. It was very exciting to find out that ketamine not only has long lasting antidepressant effects, but it also produces an almost immediate effect and quickly ends suicidal thoughts in patients.
This momentum has reached the American Psychiatric Association, which has formed a ketamine task force to assess the validity of this novel antidepressant drug. According to some of the members, the group is headed toward endorsing the drug as a viable treatment for treatment-resistant depression. There are several clinical trials that are currently working on establishing dosage guidelines for the drug. According to Dr. Enrique Abreu, an anesthesiologist who began treating depressed patients with this drug in 2012, “The response rate is unbelievable. This drug is 75% effective, which means than three-quarters of my patients do well. Nothing in medicine has those kind of numbers.”1
Though ketamine has proven to be a very promising advancement in the treatment of severe depression, patients have to go to clinics to get their ketamine injections once every few weeks and cannot take the drug in a pill form. More research has to be conducted to understand the long term side effects of this drug, but for now the field of psychiatry is very excited about this new miracle antidepressant.
1Solovitch, Sara. "Onetime Party Drug Hailed as Miracle for Treating Severe Depression." Washington Post. The Washington Post, 01 Feb. 2016. Web. 24 Mar. 2016.