Ketamine is Coming

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NPR Shots interviews some of the psychiatrists who feel that the fast-acting drug ketamine is a “revolution” in depression treatment.

“I think it’s highly probable that we’ll see some version of one of these treatments being approved in the relatively near future,” Dr. Gerard Sanacora tells NPR. “In my mind it is the most exciting development in mood disorder treatment in the last 50 years.”

NPR notes that, “Sanacora has done consulting work for both Naurex and Johnson & Johnson,” and that, “Johnson & Johnson included esketamine on a list of drugs with potential annual sales of more than $1 billion.”

Depression Treatments Inspired By Club Drug Move Ahead In Tests (NPR Shots, May 28, 2015)

35 COMMENTS

  1. Hey, heroin would work too. If the drug companies were allowed to have a monopoly, it would easily be legalized. It would keep a lot of people out of prison then. (Too bad the drug company CEOs won’t go to prison though.)

    How is that for a proposal? Do you think a drug company might hire me in their PR department?

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      • Try to be more open to ways we can prevent the suffering and death of so many people. There have been over 30 independent clinical trials conducted in the US alone that consistently prove the efficacy of Ketamine for the treatment of depression.

        At Ketamine Clinics of Los Angeles, we treat depression and other mood disorders with IV Ketamine Therapy with an 83% success rate. Almost everyone we see is and has been suffering for so long, many of them suicidal. They have treatment resistant depression, meaning they’ve tried at least 2 other conventional methods for a reasonable amount of time and they haven’t gotten relief. They come to us and we help them to truly turn their lives around.

        We are not enthusiastic about the pharmaceutical industry; we are enthusiastic about providing a treatment with no long-term side effects that can reverse suicidality in as fast as 2 hours. Where anti-depressant medications take 4-6 weeks to work if they work at all, Ketamine averages in 1-2 days. People are getting months of relief, long after any “high” wears off. And they aren’t becoming ketamine addicts, looking for their next fix to keep their depression away. We’ve done hundreds of infusions and not a single patient has exhibited any signs of addictive behavior. The stigma around ketamine is resulting in countless deaths. Many drugs that really help people are abused on the street and that will never change. Demonizing all uses of a drug because of this is a very small-minded way of thinking.

        Our treatment doesn’t stop after the infusions either. We work closely with our patients on making lifestyle changes, like diet and exercise, to maintain their good results. They get involved in talking therapy. We support them with anything they need to take their lives back, and most of them do.

        Please, don’t villainize IV Ketamine Therapy. Some of us, not all of us, but some truly do care and are doing everything we can to save lives. Not all of us have an evil agenda focused on making a profit. Feel free to learn more about our clinic and treatment at ketamineclinics.com

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        • “The stigma around ketamine is resulting in countless deaths. ”

          Sure. And that data has been pulled out of where exactly?

          Ketamine is a narcotic. Narcotics produce psychological effects. It’s not therapy, it’s drugging people. It’s just as much therapeutic as prescribing someone booze or heroin or any other mind-altering drug. I don’t care if people choose to use them as recreational drugs but I have a problem with describing this as medical therapy against psychological distress. Depression is not a disease, at best it may be a symptom and sure as hell you don’t “treat” it with narcotics.

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  2. I am really concerned about the sort of reactions to ketamine I’ve been seeing on this site. I share people’s concerns about psych drugs (I lost a decade or so of my life to them myself, so in fact I share not just “concern,” but outrage) and about the pharmaceutical industry, which I don’t trust for one moment. However everything I’ve read about ketamine–and that’s quite a lot–suggests that it can be very helpful for people suffering from severe depression.

    To take a concrete example, someone I am close to has suffered from severe depression for thirty years. It is not at all too much to say that his life has been, and continues to be, crippled by it. I believe psych drugs have contributed to that, but I also know the depression has been very real and intractable. He is exploring ketamine, both for the depression and because, if it works, he may be then able to taper off of the MAOIs he’s been taking and that are causing him major problems. Yes, he might have been better off not taking them–I tend to think so, but then I am not going to assume so, given the seriousness of his condition and his belief that they got him through the worst of it. But regardless of that, he is where he is. I cannot imagine saying to someone in his position that ketamine is simply bad, or that it is, as Ted suggests (sarcastically, I know, but still…) like heroin.

    Should we in this community perhaps stay open to possibilities that do not fit with our preconceptions? Or have I just had the wool pulled over my eyes?

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    • You have had the wool pulled over your eyes. Many people would never consider injecting heroin or using any illegal drug for that matter, but they get started on Oxycontin and eventually have to shoot H because of the cost of their habit. The situation will be similar if Ketamine is distributed as a prescription drug. When they require more and more, the cost will drive them to the illegal K. Most comes from China and it is a big problem there.

      http://motherboard.vice.com/blog/the-great-k-hole-of-china

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      • Needless to say, the wool question was rhetorical. What I would posit is that the level of uninformed certainty in comments like this, above, is remarkable similar to the smugness we all have heard coming from psychiatrists and drug companies. For my part, I will go with another approach altogether, one that actually leaves ideological baggage at the door.

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    • Ketamine is a narcotic and in higher doses an anesthetic with potentially lethal overdose effects. It’s neither safe nor effective, not anymore than other narcotics. Psychiatry is getting desperate and going more into the hallucinogens etc in the search of a “happy pill”. The problem with happy pills is that if taken by people who treat them as permanent escape from reality they become lethal. Legalize, regulate and tax the drugs, by any means, but don’t pretend that amphetamines, ketamine, or Ecstasy are medicines for the “psychiatric illness”. It’s bs.

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  3. John Lily loved Ketamine, and drug users love it too. Especially when they can’t get PCP, its little brother.
    PCP, was almost approved as an anesthetic for Labor and delivery, but a significant number of mothers who got the drug developed psychosis. Those that take it, Latino Gangs, just love to get “out there”, in the “Void”, that it creates for them.

    But one thing, they know, you can’t use this drug by yourself, cause if you do, you won’t have anyone to keep your from going off the deep end permanently.

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  4. I really have to protest. In this community, do we want to be known for hurling around insults, presumptions, stereotypes (including racially-based, above?) Or do we want to have thoughtful discussions?

    More specifically, I have read accounts from and spoken with seriously depressed people who’ve used ketamine therapeutically. I know people who use it occasionally recreationally. They do not bare the slightest resemblance to the fear-based stereotypes above and that I’ve seen previously on this issue here. I know it can, like any consciousness altering substance, become a problem for some people, and I think that requires thoughtful attention, as does the possibility that ketaminee, like other psych drugs, will draw attention away from non-drug alternatives, which I agree should be the principal focus of treatment.

    But I also would like to have an intelligent discussion on this and hope someone will join me.

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      • Seriously? No, I would not force ketamine, or any substance, (or anthing) on a patient. Nor would I keep it from any patient who wanted it for legitimate purposes. I am a strong believer in personal choice, and in cognitive freedom of all sorts.

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    • “I have read accounts from and spoken with seriously depressed people who’ve used ketamine therapeutically.”
      As they do completely useless “anti-depressants”. Even heard the word “placebo”?

      “I know people who use it occasionally recreationally. They do not bare the slightest resemblance to the fear-based stereotypes above and that I’ve seen previously on this issue here.”
      So do many people who use drugs. So do many people who abuse drugs. Not a proof for anything.

      I’m OK with people using recreational drugs if they know what they’re doing. I have a problem with selling them as “medicine” because that’s the shortest way to abuse, dependency and addiction.

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  6. Danny, I do regret that there is more anger in this discussion than is justified, and I share your concern about people who feel terrible and hope to be helped by this. But really, ketamine is just another street drug, and I don’t see how it is different in essence from heroin. Of course, chemically it is quite different, but at bottom it just gives you a high. Isn’t that what heroin does?

    And though I wrote sarcastically, I think it really is true that if we are going to encourage people to take drugs, it would be good social policy to just legalize drugs like heroin so that people who are addicted to it would not be made into criminals. I also think it’s true that if the drug corporations were given a monopoly on the production of heroin, we would start hearing in television ads that it is a wonder drug.

    I know that many people are unhappy and are willing to take psychiatric drugs to numb themselves. I have done it myself, at times. I have taken benzos, but (1) I was aware of how addictive and dangerous they can be, and (2) I really disliked how a large part of me was missing, along with the anxiety I was fleeing from. So it isn’t that I have some kind of ideological position that is just intellectual. I’m not willing to give up part of what makes me human for the sake of blotting away my emotional pain.

    But I want to repeat that I respect your position and I regret if I said anything that made you feel disrespected.

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    • Thank you, Ted, I appreciate this very much. And also know that sometimes my skin gets a little thin, in a way–partly because I yearn so much for connection and dialogue on these things–and in fact I often do find it here, earlier protestations aside.

      My own distrust of and antipathy to drug companies is considerable. Largely because I was hooked on Zoloft for fifteen years and spent another five agonizing years getting off it and am still digging myself out from that hole. But also, my mother was “psychotic” (?) and was given Thorazine when I was a child. (The alternative she was given was hospitalization.) My father then ran marketing at Smith Kline and French (now SKGlaxo), which makes Thorazine. (To see some truly alarming ads for Thorazine, which fortunately I think mostly pre-date my father, see: http://www.whale.to/a/chlorpromazine_ads.html) My father was later fired from SKF. He considered it the central failure of his life, whereas I now believe he was actually too decent a man to make it in competition with sociopaths.

      So. No big-pharma-love, or trust, here! Still, I disagree with your assessment. Ketamine has anaesthetic, dissociative, and I believe some psychedelic qualities. It certainly can have very intense effects when used in high doses (depression treatment does not; the dose is tiny compared to anaesthetic use) and can be abused and result in addiction, no question. In a sense it gets one high, but not at all in the way heroin does or even, I submit, in the way most people think of as getting high. If we broaden our definition of high, lots of things get us there: cannabis, alcohol, various plants and funguses (which both animals and people have been intentionally ingesting forever), and also things like (this may evoke ridicule from some, but I will say it anyway) lots of exercise, being in love, sex, breathwork (pranayama, holotropic) and being a child. (Andrew Weil argues cogently that children live in an essentially “high” world, where conscious and unconscious have not yet separated…and that many drugs mimic this effect.)

      The main thing ketamine seems to do therapeutically is to increase BDNF (brain…derived?…neuotrophic factor), which stimulates the growth of brain cells and synapses and increases brain connectivity. This effect is very similar to what happens with exercise, learning, occasional fasting, and social engagement. The effect is simply stronger with ketamine, and this appears to have a profoundly positive effect, not in dulling feeling, but in shifting it away from intense depressive and anxious states that typically come with having had intense physical or psychological abuse as a child–which, I think it is clear, result in major changes to brain structure, what is effectively a form of brain injury and connectivity deficit. (There is a Dr. Brooks in New York who works with ketamine and has found that the vast majority of his patients have this sort of background.) People describe being ABLE to feel for the first time in ages.

      Of course, this may all turn out to be untrue. (I have yet to observe a synapse growing, so as with all things like this, full certainty is elusive!) But I do believe there is a lot more solid evidence on this than there ever was on, say, the chemical imbalance shibboleth–which I think you and I would agree has done immeasurable damage. And I think ketamine is significantly different from the other drugs you mention. I may be wrong, but that is my best judgement so far and I want to learn more.

      Lastly, I think this is about more than people being unhappy, that the sort of distress we are talking about here is much, much more than that, and that we can’t assess ketamine without keeping that in the forefront. For people who are “unhappy” I agree this is not at all the answer, and in fact may be seriously counterproductive.

      Oh, and really lastly (!), I considered ketamine last winter and decided to try a combination of the activities I mentioned above as an alterative approach to what I’ll call the BDNF factor. It’s been great, and I’ve lost ten pounds, too! I think the biggest thing has been intermittent fasting–not hard really, just going for at least 16 hours (including overnight) a couple of times a week. It seems to mimic the conditions we mostly evolved under and to be one of these paradoxical things where a little low-level stress does wonders, in this case by stimulating various body systems to go into repair and rejeuvenation mode.

      Okay, that’s the end of that tome, thanks for listening!

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      • p.s. I know ketamine is used “recreationally” as a street drug, but just to add that if you read the accounts of people who’ve had therapeutic treatments you don’t get this impression at all. Some people find the experience neutral, some refer to “side-effects” as a negative, some find it pleasurable, some find it opens up a space where they get fruitful insights into their own consciousness. Most of them are focused on the after-treatment (after-high) effects and seek to have the treatments as infrequently as possible because of the time and money required.

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          • Sure. The standard treatment, and what most research has used, is a 40-minute IV drip in order to get steady and controlled release into the bloodstream. This seems to be at least somewhat important to causing a sustained and effective elevation of BDNF. (I believe it’s more complicated, that’s my shorthand and I think the essence of it.) Some people get lasting or even permanent relief with one treatment, but that’s rare–probably extremely rare for “permanent”. More commonly people will get relief (when it works, about 70% of the time) for a few days to a few weeks. Typically, people will have several treatments over a few weeks to get cumulative effect, and then maintenance treatments everywhere form a few weeks apart to six months or a year. The more people develop healthy, fulfilling lives, at this point, the less frequent maintenance needs to be and the higher chances of full recovery with no maintenance. (Personally, I see it as ideally a spingboard to being able to deal with depression without drugs.) A crucial point, of course, is that ketamine is in your system for a very brief time. I do not at all assume there may not be potential long-term side effects, but it does seem to be a much safer and more benign thing than traditional psych meds.

            There has also been a bit of research suggesting that intranasal delivery (nasal spray) can be effective, and some patients report it so, but it’s trickier because a) bioavailability is variable so dosing harder to determine, and b) there is then, with a use-at-home prescription, potential for overuse. Pills are also possible, but bioavailability is even lower (though more consistent than nasal) and potential for abuse seems much reduced because effects are milder. There’s been some research using oral for hospice patients, to relieve end-of-life anxiety and depression, and it suggests pretty good results for this. (I’d emphasize it does not dope people up the way benzos, often used in this context, do. It seems to maintain normal emotional status and awarness. My partner is a hospice nurse and strongly anti-drug but feels ketamine seems like a helpful tool in these situations.

            Then it can also be used intramuscularly (injection) and there are a few papers from India, very preliminary, showing good results with that for acutely suicidal patients. (And we really are talking here about people who could be dead soon, who are actively looking to kill themselves and try this as a last resort.) Of course, with these other methods, there is real overlap with recreational use and potential for abuse. I think that’s part of why most places limit treatment to supervised IV. Problem is that’s very expensive and not now covered by insurance.

            So that’s the lay of the land as I see it.

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  7. You know something. I would hate to have a doctor be able to use this shit on me, to have my brain fucked up at his “compulsion” when later down the road I will be fine naturally.. but the risk, to our brains being fucked up, for no reason. These drugs ought to be banned completely because no one needs them and society got by fine without them. http://www.ObamasWeapon.com

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    • I doesn’t F**k up your brain. Its a safe drug that has been FDA approved for 50 years. A great deal of research supports its efficacy.

      You know what really f**ks up your brain? Putting a bullet in it because you can’t stand the pain of living anymore and you have no hope. Or stepping off of a bridge. These things really f**k up your brain. Please, do some more reading about this matter before you post again.

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      • Hmm, I seem to recall the same promises being made regarding Prozac being completely safe when that wasn’t the case.

        Anyway, can you post the links claiming efficiency so people evaluate its merits? Hopefully, you can provide access to full texts and not just abstracts.

        By the way, I am not against people being given Ketamine as long as it is a fully informed choice. But when you claim a drug is completely safe, I start getting very suspicious but even the most benign med has side effects.

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        • Who needs studies and trials? Ketamine Clinics of Los Angeles provides us with “a very simplified explanation” as to “How Ketmine Works” for even “TRD” (Treatment Resistant Depression). “Growing evidence suggests” (where have we heard THAT before?) that ketamine – wait for it – CORRECTS A CHEMICAL IMBALANCE IN THE BRAIN! Ta Daaa! Just like the marketers of Prozac claimed that it corrected a chemical imbalance! Who needs science when you can fall back on marketing spin? Here’s the link to “How Ketamine Works” on the website for Ketamine Clinics of Los Angeles:
          https://www.ketamineclinics.com/how-it-works.html

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          • Well that is alarming. I do think they’re wording is more tentative and nuanced than you suggest. Still, they’re tapping into this myth in a way that does make me worry, down the road, once J&J or whoever develops a derivative without the dissociative effects for at-home use (I believe that’s where they’re headed), which of course they will then patent and market like crazy (ketamine itself is not patented, or it has expired, so there’s no big-pharma there) that this will then put it into the mass-use pipeline. Even if it proves to be significantly safer and more effective than SSRIs (which seems pretty likely to me, that will then perpetuate (“prove”!) that “chemical imbalance” is the root of all troubles and discourage non-drug approaches, happy-happy social conformism, etc.

            Thank you for digging that up.

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          • Great, so add the recycling BS of “Growing evidence suggests that Ketamine corrects a chemical imbalance” to previous BS claim that it is completely safe. This recycled crap really gets old.

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          • Well, Danny S, if “nuanced” is a synonym for “sneaky,” then I guess I would agree with you. What Ketamine Clinics of Los Angeles has done here is simply dress up a marketing message in sciencey-sounding language.

            I agree with AA. This chemical-imbalance-in-the-brain message is so much recycled crap.

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          • Suzanne, either way, I really do thank you for finding that and helping me to see how there could be some unfortunate outcomes with this down the road.

            By the way my earlier comment should have said “discourage non-drug approaches and ENcourage happy-happy social conformism.”

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      • FDA has also approved anti-cancer chemotherapy. It does not make it safe and effective for treating acne. Ketamine is an anesthetic and quite effective at that but that does not mean it’s safe and effective for anything else.

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  8. Drugs should not be the “go-to” option for treating depression in my opinion. I was on medication for years and saw no improvement with them and the side-effects can be horrific. The http://destroydepression.com system written by James Gordon was a life-saver for me. It teaches 7 natural steps including MBCT which totally turned my life around. These kinds of treatments have a much higher success rate than AD medication and don’t cost anywhere near the amount that medication does.
    All the medical association seem to want to do these days is throw drugs at every ailment, they need to start looking at causes of depression and treat that, not just mask the symptoms with chemicals.

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  9. One thing I know, for sure is that drugs are always a false hope. And when you are hopeless, anything that seems hopeful, is like a miracle.

    Unfortunately, people who feel that way, will do just about anything to get some relief. And those that sell drugs are aware of this. Whether the are drug dealers or pharmaceutical companies.

    Unfortunately, we cannot rely on anecdotal evidence for any treatment, because that isn’t realistic. Seems like there is always someone available to take advantage of this situation.

    There are ample examples of hundreds of drugs that have been tried to treat depression, in the end they are either unpredictable, ineffective, cause serious damage to the brain, or appear to work because they blur cognitive awareness and insight of those prescribed.

    Ketamine, and PCP, are dissociative anesthetics, and they have been studied for a long time. They were in fact not approved because of the serious side effect of triggering psychosis, through disassociation in roughly 40% of those given the drug. Many treatments cause disassociation, and in these drugs, with seriously depressed individual, encouraging dissociation, is a disaster.

    I have had a long history of working with street drug users, and these drugs are dangerous and frightening. I have had real hands on experience working with lots and lots of users of these drugs.

    Even in the drug using sub culture, users of these drugs are considered dangerous. Its not just a scare story, this is what I have observed first hand, on the streets where these drugs are used habitually.

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    • Dear PD, I think your experience may be with a limited set of drugs and drug users. I can say from my own experience that, to take the example I’m most familiar with, psychedelics can help to facilitate profound healing, and I know many others who have had the same experience, and therapists who have worked with the substances to the same effect, and we can now add to that careful, nomothetic (non-“anecdotal”) research in the past ten years by scientists who’s work runs entirely counter to the interests of big pharma and mainstream psychiatry. All this can, of course, be dismissed, as anything can be, out of hand, but my feeling is that it is better to actually look at the evidence that does not fit what you have outlined above. (It may not, in the end, mean what I think it does, but we can only establish that if we actually consider it with an open mind.) I also disagree that “anecdotal” equates with being not realistic, as you suggest. There is a fine line between anecdotes and inductive research or more broadly inductively-produced knowledge. The problem lies only in confusing the two–which would happen, for instance, if you took the experience I mention above and try, mistakenly, to come to a quantitative/statistical conclusion about overall effects across a population. To take one example, I doubt Darwin ever did a double-blind trial or statistical analysis. His work was primarily inductive, it used careful “anecdotal” observations to examine and make sense of patterns and processes. He learned some pretty interesting things that have held up to scrutiny over time. To dismiss this dimension of the larger research process, or simply of human understanding, seems mistaken to me.

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  10. My own experience is running one of the largest drug treatment families on the west coast for 8 years, and running drug diversion groups for Los Angeles County that treated thousands of drug users. I have literally worked with thousands of drug addicts. .

    My experience working with Psychedelic drug users is they are people who typically are shut down emotionally, and are head oriented. They like psychedelic drugs because they can finally feel something intensely, unfortunately, continued and prolonged use of psychedelics, damages the brains ability to repress. That can lead to continual intrusion.

    Once they begin dealing with intrusion on a continual basis, usually will gravitate toward drugs that help them repress. This is why you don’t see 12 step groups, that are oriented to psychedelic drug use solely, like say alcoholics anonymous. Because they cause psychosis, to emerge long term. I have treated any number of people who “lost it on these drugs.

    Don’t confuse the lifting of repression with a cure, its not. Because people need defenses in order to process emotional pain. Without them they are always overloaded and in psychic distress.

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    • Prisoners,

      What you point to seems very important, and, from my angle, certainly argues that such substances are not for everyone, or for anyone all the time, and should be used with care. I have not seen what you describe, though I’ve assumed it is out there, but I have seen something perhaps related, where people seem to feel their experiences, because of the great intensity, have given them a direct pipeline to divine truth and can get rather screwy in their thinking. I think it’s important to make sure people know about such risks in the midst of the current resurgence in psychedelics and the tendency of many users to assume that, because they are safer than other drugs, they are therefore totally safe.

      It still seems to me, however, that you have a very particular, and in important ways limited, window on this. Going back to the question of anecdotes and qualitative accounts, it seems a safe bet that we should not extrapolate from an addiction clinic to the larger population, since the latter is a far, far more varied and diverse set. Then there is the question of your own personal interpretation of what you have seen, and especially what to do with the accounts of other addiction specialists that diverge from your own. That would include Bill Wilson, founder of AA, who was in favor of making psychedelic work part of the protocol there (his board, rightly, felt it would be too controvercial); Gabor Mate, who has spent years in the trenches working with addicts and finds ayahuasca to be very helpful in treating addictions and psychic healing more generally; Dmitri Mugianis, who broke a decades-long addiction to heroin with the help of ibogaine and has gone on to work with many addicts in this vein in New York and elsewhere; and Jaques Mabit, a French M.D. and addiction specialists who runs a clinic in Peru that has high efficacy working with ayahuasca. Then there is the work of Teri Krebs, in Norway, that shows in the general population a small positive relationship between both recent and lifetime psychedelic use and mental health status. Also recent work from Rowland Griffith’s lab at Johns Hopkins finding about an 80% success rate using psilocybin in a smoking-cessation program.

      So, what to do with all that? Ketamine, of course, is not the same, but I believe there are similarities in the way the debate plays out.

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