Ketamine in the Media

Claudia Kieffer remembers the first time she encountered the drug she describes as having “saved my life”. Eight years ago, Kieffer, who had suffered from treatment-resistant depression for decades, was given ketamine as a routine anaesthetic, as part of a post-mastectomy breast reconstruction procedure.

But as well as alleviating the pain, Kieffer noticed an instantaneous change in her state of mind.

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Three years ago, I felt like I was just keeping my head above water. I’d tried dozens of medications and years of therapy for my depressive bipolar episodes, but nothing was providing real relief. I struggled to leave the house; I couldn’t work. Little things would set off my anxiety. I constantly questioned why I was so sad. But after so many failed treatment plans, I thought this was my life.

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A new medication related to the iconic party drug "Special K" that can rapidly treat depression could revolutionize the treatment of the condition affecting more than 16 million Americans, experts say.

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The Food and Drug Administration approved the first drug that can relieve depression in hours instead of weeks.

Esketamine, a chemical cousin of the anesthetic and party drug ketamine, represents the first truly new kind of depression drug since Prozac hit the market in 1988.

The FDA's decision came Tuesday, less than a month after a panel of experts advising the agency voted overwhelmingly in favor of approval.

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A nasal spray version of the drug ketamine has shown promise as an antidepressant, even if its properties still aren’t well understood.

Of the 16 million American adults who live with depression, as many as one-quarter gain little or no benefit from available treatments, whether drugs or talk therapy. They represent perhaps the greatest unmet need in psychiatry. On Tuesday, the Food and Drug Administration approved a prescription treatment intended to help them, a fast-acting drug derived from an old and widely used anesthetic, ketamine.

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PHILADELPHIA -- The FDA could soon approve a unique treatment for depression, a version of a drug that some people use to get high: ketamine.

This would be the first new therapy in three decades.

Depression affects millions of Americans and for many traditional anti-depressants don't work.

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Joe Wright has no doubt that ketamine saved his life. A 34-year-old high school teacher who writes poetry every day on a typewriter, Wright was plagued by suicidal impulses for years. The thoughts started coming on when he was a high schooler himself, on Staten Island, N.Y., and intensified during his first year of college. “It was an internal monologue, emphatic on how pointless it is to exist,” he says. “It’s like being ambushed by your own brain.”

He first tried to kill himself by swallowing a bottle of sleeping pills the summer after his sophomore year. Years of treatment with Prozac, Zoloft, Wellbutrin, and other antidepressants followed, but the desire for an end was never fully resolved. He started cutting himself on his arms and legs with a pencil-sharpener blade. Sometimes he’d burn himself with cigarettes. He remembers few details about his second and third suicide attempts. They were halfhearted; he drank himself into a stupor and once added Xanax into the mix.

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It’s estimated that more than 16 million adults in the United States have had at least one major depressive episode, according to the National Institute of Mental Health. And for up to 30 percent of them, antidepressant treatments simply didn’t work, or worked only a little, according to a study published in Patient Preference and Adherence. But a new use for an old drug — ketamine — has shown some promise. Here’s what you need to know.

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Lauren Gletner had hit rock bottom. A high school secretary in Martinsburg, West Virginia, the 51-year-old had battled debilitating depression since her early twenties. Yet over the last few years, the profound sadness that left her feeling hopeless and unable to get out of bed had become much worse. She had begun self-medicating with alcohol and had even attempted suicide. “I tried every prescription drug out there, and the side effects were intolerable,” she says. “I was in therapy, but because my depression was the result of a chemical imbalance, it didn’t help.”

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In May of 2017, Louise decided that her life was just too difficult, so she’d end it. In the previous four years, three siblings and a half-sibling had died, two from disease, one from fire and one from choking. Close friends had moved away. She felt painfully, unbearably alone. It would be the fourth time Louise (I’m using her middle name to protect her privacy), then 68, would attempt suicide, and she was determined to get it right.

She wrote a letter with instructions on where to find important documents and who should inherit what. She packed up her jewelry and artwork, addressing each box to particular friends and family members. Then she checked into a motel — homes where people have committed suicide lose value and she didn’t want hers to sell below market — put a plastic sheet on the bed, lay down and swallowed what she figured was an overdose of prescription pills with champagne.

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In patients with severe depression and thoughts of suicide, ketamine is emerging as a potential treatment. Patients are given roughly 5 to 6 injections of the party drug and have reported almost immediate relief from suicidal thoughts and major depressive disorder.

One such patient, Alan Ferguson, had been battling depression his whole life and had attempted suicide multiple times. In the midst of a major depressive episode, the 54-year-old was put in touch with Dr. Kevin Lane, an anesthesiologist who is currently administering ketamine treatments. After receiving one treatment of intravenous ketamine therapy, Ferguson claims to have woken up the next day with no thoughts of suicide. Receiving three of the injections in total, he describes the drug as a “medical marvel”.

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A few months ago, Alan Ferguson decided he was ready to die -- for the third time. In 2014, he attempted suicide twice, and the persistent thoughts of "I need to be dead" were echoing in his brain once again.

Now 54 years old, Ferguson was diagnosed with clinical depression when he was 18. Since then, he estimates, he's been prescribed more than a dozen medications -- SSRIs, SNRIs, tricyclic antidepressants -- all to little or no avail.

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There’s a new treatment that’s gaining traction as a wonder drug for depression — and that’s ketamine. According to its advocates, medically administered ketamine infusions have the potential to revolutionize the way doctors treat depression — and give people struggling with depression unprecedented relief from their symptoms.

For people struggling with depression, treatment is crucial. Unfortunately, traditional treatments don’t work for everyone; about 30% of people with depression don’t respond to traditional pharmaceutical treatment, and even for people who do respond, antidepressants can take up to eight weeks to take effect — which, when you’re struggling with depression, can feel like a lifetime.

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A North Texas woman said a popular club drug and animal tranquilizer saved her from a life of depression and suicidal thoughts.

You may have heard of the drug before, as Special K on the street. it was designed as a horse tranquilizer, but Ketamine is gaining popularity as a treatment for depression.

Some doctors believe the controversial drug will become a game-changer in slowing the nation's suicide epidemic.

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I am here because I cannot stop thinking about suicide. I’ve been in therapy on and off for more than 30 years, since I was 5, and on depression medication for more than a decade. Nothing seemed to work. I couldn’t stop imagining killing myself in increasingly vivid daydreams.

As a journalist who covers health and medicine, I had read about the success of experimental trials that used ketamine to treat depression. My therapists had recommended extreme treatments like electroshock therapy, a procedure that frightened me due to reports of memory loss from those who had undergone it, but had never mentioned this. But I was getting desperate for a serious intervention.

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Ketamine was developed as an anesthetic for surgery and trauma. It was approved by the FDA in 1970 for human use, with indications as for the sole anesthetic agent for diagnostic and surgical procedures that do not require skeletal muscle relaxation. Ketamine was then literally battle-tested during the Vietnam War, where it was vital in caring for wounded soldiers.

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RENO, Nev. — Dr. Robert Watson was walking to the hospital one day when he heard a woman call out to him.

The woman, he quickly realized, was the mother of a patient whom he recently treated. "She told me, 'Oh my gosh! Thank you; thank you so much!'" Watson recalled.

Not long before, the woman had called Dr. Watson's office out of desperation. She was seeking help for her daughter, who was suffering from an anxiety disorder — she was crippled by it and unable to work.​

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Ketamine has caused quite a stir in psychiatric practice. Sub-anesthetic administrations of ketamine have been shown to markedly improve symptoms of depression and anxiety. While the growing off-label use of ketamine speaks to the need for novel approaches to psychiatric care and treatment-resistant illness, it also presents an ethical dilemma, wherein widespread adoption has once again leaped ahead of scientific understanding.

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For six years now, life has been really good for James. He has a great job as the creative director of an advertising firm in New York City. He enjoys spending time with his wife and kids.

And it has all been possible, he says, because for the past six years he has been taking a drug called ketamine.

Before ketamine, James was unable to work or focus his thoughts. His mind was filled with violent images. And his mood could go from ebullient to dark in a matter of minutes.

Ketamine "helped me get my life back," says James.

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Every week, when Ian Hanley sits down with his therapist, he goes through a list of depression treatments he’s been researching online. The best-known treatments at the top of the list–half a dozen antidepressants and known combinations of those drugs–are all crossed out.

“My therapist says he’s never had this much difficulty with somebody,” says Hanley, “which is sort of a dubious honor.”

Hanley is only 21 years old, but he’s already six years into his search for something, anything, that can help him feel better for more than a few weeks at a time.

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Like a May shower, the studies on psychedelic drugs' potential therapeutic benefits came — first as a sprinkle, then a steady downpour. Between 2012 and 2017, the papers abounded. One, published in 2016, suggested that magic mushrooms might alleviate anxiety in cancer patients; another in 2017 indicated that ecstasy could help veteranscope with PTSD symptoms; and one in 2012 hinted that ketamine might curb major depression.

Recently, the shower has turned into a trickle. But that spate of published research on psychedelics now seems to be leading to the development some promising potential treatments.

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It all started with ketamine. To some, vets mainly, it’s a horse tranquilizer. To others, a party drug. To those with severe clinical depression, a potential, literal, life-saver. A dose of ketamine can rapidly dull the symptoms of depression, providing immediate relief for those crippled by the darkest thoughts. And while ketamine does not work for everyone, it seems to work in many people who are untouched by standard antidepressant drugs.

Ketamine could then be our best lead in the hunt for depression. For if we search for where ketamine affects the brain, and for how it affects the brain, we will get vital clues to the cause of depression. And so to a long-lasting effective treatment. Two studies just published in Nature used precisely this trick, and spectacularly uncovered not just compelling evidence of the tiny brain region to target, but exactly what goes wrong in it to create depression — that some neurons are, literally, depressed.

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When confronted with a suicidal patient, doctors could turn to a substance with uses that range from psychedelic party drug to animal anesthetic.

It’s called ketamine, a class III scheduled drug known for its similarities to PCP and its ability to induce dissociative and hallucinogenic feelings. The drug is the most commonly used among veterinarians for anesthetic purposes, according to Medical News Today, but is often illegally used in clubs and as a date-rape drug.

And now a study published in The American Journal of Psychiatry suggests the powerful drug could also help treat suicidal people.

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Don’t people take ketamine at raves?
Well, yeah. Club kids call it Special K and snort it for its dissociative, dreamy effects. But it’s also been used as a (legal) anesthetic since the ’70s. In the early 2000s, doctors realized it quickly treats depression and began prescribing it in small doses. Researchers theorize it works by blocking cells from firing in the lateral habenula, an area of the brain that represses reward centers, according to a study released in February. (Maybe it’s also got something to do with those dissociative effects?)

How does it get administered at clinics?

First, you need a prescription from your doctor. Then, after a consultation at the clinic, you’ll hang out in a recliner for 45 minutes or so while an IV drip infuses the drug into your bloodstream. A nurse monitors your blood pressure and heart rate. (Be wary if the clinic doesn’t track your vitals.)

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It's been called "the most important discovery in half a century," and for some of the people who have tried ketamine, it may feel that way too.

The compound has a reputation as a party drug, but ketamine is increasingly being studied for its potential use as a rapid-fire treatment for depression. In people who live with the disease, thoughts of suicide can strike suddenly and without warning. Fast-acting, successful interventions are hard to come by.

But a spate of recent research suggests that ketamine could provide quick and powerful relief — even to people whose depression has repeatedly failed to respond to other medications and to those who are suicidal.

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The notorious party drug may act as an antidepressant by blocking neural bursts in a little-understood brain region that may drive depression​.​​

Ketamine has been called the biggest thing to happen to psychiatry in 50 years, due to its uniquely rapid and sustained antidepressant effects. It improves symptoms in as little as 30 minutes, compared with weeks or even months for existing antidepressants, and is effective even for the roughly one third of patients with so-called treatment-resistant depression.

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Unipolar major depressive disorder (MDD) is one of the leading causes of disability, affecting 16 million individuals in the United States, and more than 300 million individuals worldwide experience depression. Roughly one-third of patients with MDD do not respond to currently approved antidepressants, and even in those who do, these agents typically take several weeks or even months to achieve a significant effect.

“There is a major unmet need for more effective and rapidly acting antidepressants,” commented Dan V. Iosifescu, MD, director of clinical research, at the Nathan Kline Institute and associate professor of psychiatry at New York University School of Medicine.

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Doctors trialling the use of ketamine to treat depression are calling for the treatment to be rolled out.

Ketamine is licensed to be used as an anaesthetic but has a reputation as an illegal party drug.

Writing in The Lancet Psychiatry, Dr Rupert McShane, who has led a trial in Oxford, since 2011 says ketamine can work on patients with depression "where nothing has helped before".

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It's more commonly used as a recreational drug or anaesthetic, but Australian researchers are hoping ketamine may be the key to treating severe depression -- and the results are good.

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Tens of thousands of people with severe depression could benefit from taking ketamine, the illegal party drug, and the NHS needs to gear up for more widespread use, doctors say.

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LONDON (Reuters) - The party drug ketamine can have powerful beneficial effects on severely depressed patients who have struggled for years to recover, and the drug should be developed responsibly as a psychiatric medicine, British experts said on Thursday.

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How the party drug ketamine may hold the key to treating patients with severe depression

One in four people in the UK experience a mental health problem each year, according to mental health charity Mind. And while the majority improve with time, exercise, talking therapies or antidepressants, a significant number do not. For these so-called treatment-resistant patients, the landscape of alternative clinical options is bleak.

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The Ketamine Papers opens the door to a broad understanding of this medicine s growing use in psychiatry and its decades of history providing transformative personal experiences. Now gaining increasing recognition as a promising approach to the treatment of depression, posttraumatic stress disorder (PTSD), and other psychological conditions, ketamine therapies offer new hope for patients and clinicians alike. With multiple routes of administration and practices ranging from anesthesia to psychotherapy, ketamine medicine is a diverse and rapidly growing field.

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A ‘club drug’ used as an anesthetic can help clear up the distraught thinking of people on the brink of suicide, researchers reported Tuesday.

Half the patients given infusions of ketamine said they experienced relief from their thoughts of suicide, Dr. Dawn Ionescu of Massachusetts General Hospital and colleagues reported.

These were all patients who could not be helped by antidepressants, other drugs or therapy, the team reported in the Journal of Clinical Psychiatry.

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Everyone’s depression is different, but Ted, a 40-year-old resident of Portland, Oregon, describes his as a “continuous dark veil — a foul, dark, awful perspective that informs every moment of your whole life.” He’d tried to treat it with antidepressants, therapy, visits to psychiatrists, “the whole nine,” but although the antidepressants kept him functional, they by no means offered relief. He was getting desperate, so when his sister — an obstetrician who works in New York — mentioned the National Institute of Health was conducting experimental studies using ketamine to treat depression, he gave them a call.

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It may take some time to get the general public used to the idea of treating mental illness with drugs many associate with hard partying, but the medical community is jumping aboard the psychedelics train.

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It was November 2012 when Dennis Hartman, a Seattle business executive, managed to pull himself out of bed, force himself to shower for the first time in days and board a plane that would carry him across the country to a clinical trial at the National Institute of Mental Health in Bethesda, Md.

After a lifetime of profound depression, 25 years of therapy and cycling through 18 antidepressants and mood stabilizers, Hartman, then 46, had planned to commit suicide if this clinical trial didn't work.

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It was November 2012 when Dennis Hartman, a Seattle business executive, managed to pull himself out of bed, force himself to shower for the first time in days and board a plane that would carry him across the country to a clinical trial at the National Institute of Mental Health (NIMH) in Bethesda.

After a lifetime of profound depression, 25 years of therapy and cycling through 18 antidepressants and mood stabilizers, Hartman, then 46, had settled on a date and a plan to end it all. The clinical trial would be his last attempt at salvation.

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Charlie, a 34-year-old from Atlanta, Georgia, had been suffering from depression since he was 20 years old. Depression manifests differently both in degree and kind, and over the years Charlie’s has been severe and intractable. He has been on a litany of antidepressants – Prozac, Cymbalta, Zoloft – none of which had a lasting impact on his symptoms. He eventually came around to trying electroconvulsive therapy (ECT) in 2006 at a mental health treatment centre in Atlanta.

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On the seventh floor of a building overlooking the Federal Reserve Bank in lower Manhattan, two medical clinics share an office. One is run by a podiatrist who’s outfitted the waiting room with educational materials on foot problems such as hammer toes and bunions. The other clinic doesn’t have pamphlets on display and offers a much less conventional service: For the advertised price of $525, severely depressed and suicidal patients can get a 45-minute intravenous infusion of ketamine—better known as the illicit party drug Special K.

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