The United States has an alarmingly high level of morbidity of depression and suicide – one of the severest consequences of depression – a leading cause of deaths. Many of us often ignore depressive symptoms, sometimes due to ignorance and sometimes due to stigma attached to depression, a serious mental disorder. As a result, many patients use alcohol, ketamine, etc. to self-medicate.
While self-medication is nothing but playing with fire, now ketamine has been acknowledged as a potential treatment for depression. As per a new study published in the American Journal of Psychiatry (AJP) on April 18, 2018, a nasal spray containing ketamine can alleviate depressive symptoms and suicidal thoughts. The study was double-blind in which the standard treatment and an intranasal formulation of esketamine (part of ketamine) was compared with standard treatment and a placebo to investigate the most effective treatment for major depression among individuals at high risk of committing suicide.California Center for Psychedelic Therapy is one of the authority sites on this topic.
The study was carried out by the researchers from the Yale School of Medicine, New Haven, Conn. and Janssen Research and Development and Janssen Scientific Affairs, Titusville, N.J., and San Diego. The participants comprised 68 individuals who were randomly assigned to receive either the intranasal formulation or placebo two times a week for a total duration of four weeks. A standard treatment with antidepressants was provided to all the participants throughout the study duration. Suicide ideation was measured basis the perspectives of both patients and clinicians.
The effects were studied at four hours after the first treatment, after 24 hours and after 25 days. At the end of the study duration, significant improvement in the depression scores was found in the esketamine group at four hours and 24 hours after the treatment. However, the effect after 25 days was not pronounced in the esketamine group as compared to the placebo.
Most antidepressants take at least four to six weeks to show their effects and the delay can be bridged by using the esketamine spray due to its rapid effects on patients struggling with depression and those with an increased propensity to suicide. This was a phase-two study and before receiving the approval of Food and Drugs Administration (FDA), it must undergo phase-three study, as per the authors. However, ketamine use comes with a warning.
Abuse potential of ketamine
Despite the potential benefit of ketamine therapy, the authors have warned against its abuse potential. Many people struggling with the pain of mental health issues get into substance abuse to mitigate their suffering. With long-term use of any drug, they can become dependent or addicted. When an individual suffers from both mental health and substance abuse problems, the condition is known as co-occurring disorders or dual diagnosis. Co-occurring disorders treatment has to take into account both the conditions and treat them simultaneously for better outcomes.
Alongside the article, an editorial was also published by the AJP editor, Robert Freedman, and additional members of the board. The authors noted the abuse potential of ketamine after analyzing the existing reports of abuse of the prescribed drug. They emphasized on the need for further research in this domain during the phase-three trial, like investigating cravings and potential use of ketamine from other sources.
The authors acknowledged that it is their responsibility as well to prevent a new drug epidemic. They also suggested the necessity of having more inputs for development of effective controls on use and distribution of ketamine. According to Freedman and colleagues, steps taken to control ketamine use would not hamper its usage for the needy population. It will rather protect those who are at risk of abusing it.