suicidal-thoughts

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Ketamine, a potent anaesthetic but also popular recreational drug, quickly reduces suicidal thoughts, according to the first study that examined this effect in particular. A body of evidence already supports ketamine’s therapeutic effects in patients suffering from chronic depression.

“Currently available antidepressants can be effective in reducing suicidal thoughts in patients with depression, but they can take weeks to have an effect,” explains Michael Grunebaum, a psychiatrist at Columbia University Medical Center, and the study’s lead author. “Suicidal, depressed patients need treatments that are rapidly effective in reducing suicidal thoughts when they are at highest risk. Currently, there is no such treatment for rapid relief of suicidal thoughts in depressed patients.”

Ketamine — suddenly making life worth living

The psychiatrists enlisted 80 patients who were diagnosed with “clinically significant suicidal thoughts” and gave them either a low dose of ketamine or a sedative called midazolam, which is commonly prescribed for patients with acute suicidal thoughts. Compared to the midazolam group, the patients who were given the ketamine showed a marked reduction in suicidal thoughts only 24 hours after the drug was administered.

Remarkably, even six weeks after the low-dose treatment, the ketamine group retained this effect. The ketamine group also reported an improvement in mood, as well as depression and fatigue symptoms, indicating that ketamine has a broad effect on psychiatric well-being, as reported in American Journal of Psychiatry.

“This study shows that ketamine offers promise as a rapidly acting treatment for reducing suicidal thoughts in patients with depression,” says Grunebaum. “Additional research to evaluate ketamine’s antidepressant and anti-suicidal effects may pave the way for the development of new antidepressant medications that are faster acting and have the potential to help individuals who do not respond to currently available treatments.”

First developed in the 1960s, ketamine has recently seen a revival in a therapeutic setting after decades of being notorious as a party drug. Scientists say the drug “blew the doors off what we thought we knew about depression treatment.” One 2013 study involving 73 participants found ketamine relieved depression symptoms in 64% of patients who had tried three or more other medications with unsuccessful results — all in less than 24 hours. Other studies have reached similar conclusions. “Feeling better faster, getting the mood to improve faster — that’s why ketamine is very promising,” said Alan Manevitz, MD.

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Ketamine clinics have been popping up like mushrooms

That’s not to say ketamine is a ‘miracle drug’. Anecdotally, we know that ketamine has a high potential for abuse and its long-term effects on the body are poorly understood. Daniel Lodge, Ph.D., of The University of Texas Health Science Center at San Antonio, found that ketamine activates the ventral hippocampus (vHipp)-medial prefrontal cortex (mPFC) pathway in rats. When this happened, anti-depressant effects were incurred, whereas preventing activation of the circuit eliminates the antidepressant-like effects of ketamine. Using this information, Lodge says that it’s possible to one day develop a drug that targets this neural pathway only. In other words, a drug that has all of ketamine’s good stuff but none of the abuse-inducing side effects.

In the United States, particularly in California, a number of clinics are already offering ketamine infusions. Anecdotal reports suggest they succeed in reducing depression symptoms among hard-case patients, who pay top dollar for an otherwise generic and cheaply sourced substance. For depression, the price per infusion ranges from $400 to $1000.

A number of clinicians and medical organizations, however, have raised serious concerns about the lack of regulatory or legislative oversight. “It scares the hell out of me that this is still unregulated,” said Steve Levine, MD, a psychiatrist but also the founder of a clinic who offers ketamine infusions.

In April, an article published online in Lancet Psychiatry, researchers called for better oversight.

“We find that, based on current evidence, ketamine use for severe, treatment-resistant depression does not violate ethical principles,” they write.

“However, clinicians and professional bodies must take steps to ensure that guidelines for good practice are enacted, that all experimental and trial data are made available through national registries, and that the risk potential of ketamine treatment continues to be monitored and modelled.”

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