Mental health: they investigate whether a controversial drug cures depression

Could the ketaminea molecule with a controversial reputation, helping some patients with depression? Some research confirms this, but experts remain cautious in the face of the challenge of possible side effects.

Positive research accumulates, especially when no other treatment works.

“We urgently need new treatments for severe depression and ketamine shows promise”summarizes the Australian researcher Julaine Allan, specialized in mental health.

What is ketamine?

Ketamine is not a classic antidepressant like those developed since the 1960s.

It is, in principle, an anesthetic, but for about twenty years psychiatrists have considered it a possible solution against depression.

Unlike regular antidepressants, ketamine acts quickly, although it is unknown exactly what physiological mechanisms it provokes to relieve depressive symptoms.

Therefore, it seems promising in two main cases: cWhen specific and urgent treatment is needed, mainly in the face of suicidal crises, although not only in those cases. AND when no classic medication works, that is, in cases of so-called resistant depression.

In recent months, several studies published in prestigious journals have confirmed the interest of ketamine in these two cases.

In what cases was its use effective according to the studies?

A study published in April in the British Medical Journal shows how young mothers’ risk of postpartum depression was reduced after receiving a single dose of esketamine, a ketamine derivative, when your baby is born.

In the second case, a study published this Monday in Nature Medicine shows that treatment with ketamine prevented more depressive relapses compared to patients receiving placebo treatment.

The small size of these samples (a little more than one hundred people) and some methodological aspects suggest that it is too early to draw firm conclusions.

Positive climate in the medical community

But these studies feed a corpus favorable to the use of ketamine against depression, a benefit that no longer generates many doubts among psychiatrists.

“It should be considered as an intermediary between classic antidepressants and electroshocks,” explains Geneva psychiatrist Michel Hoffmann, who mentions a real “enthusiasm” in the medical community.

“For patients in whom classic treatments do not work, ketamine offers the possibility of ruling out electroshocks,” he says.

But although esketamine has been approved for several years in the United States and Europe for certain depressions, some psychiatrists remain reluctant.

What are the risks of its use?

Without denying the effectiveness of ketamine, these specialists fear the addiction riskespecially because the molecule is often diverted as a drug, a use sadly covered by the media due to the overdose death of personalities such as the American actor Matthew Perry.

“Will ketamine soon be administered to patients with suicidal ideas? Difficult to say, since there is a real risk that extensive use of ketamine will provoke a new opioid crisis,” psychiatrist Riccardo De Giorgi warned in 2022 in the BMJ, in reference to the health crisis that has caused hundreds of thousands of deaths in the United States due to the improper or excessive use of certain medications.

The challenge is, therefore, to reduce the risk of abuse, as well as the severe side effects, such as the appearance of dissociative personality disorders.

How is its administration controlled?

That is the great interest of the study published by Nature Medicine: to test a new way of administering ketamine, using a tablet that progressively releases the treatment in the body.

Potentially, that use is more practical and less risky than an intravenous treatment or a nasal spray, the two forms under which esketamine is currently approved.

The study offers promising results from this point of view, although, again, they will need to be confirmed.

“Patients reported few side effects: euphoria, dissociation…”, reports its lead author, Paul Glue. “So, I don’t think these tablets will attract people who want to abuse ketamine.”