Wednesday, May 12, 2021

Comments by steve1930

Showing 3 of 3 comments.

  • AA
    I guess I’m meaning that the evidence that ketamine is helpful is available and it is not perfect for some very practical reasons. However what is known is sufficient for doctors and their patients to have a discussion of the risks versus the benefits of trying it for treatment resistant conditions. Professor Collen Loo in Australia has just today received a 2 million dollar grant to conduct a multi-center trial on 200 patients using ketamine versus an active placebo which will give us more information to work with.
    In any field new treatments invariably go through phases of excitement then despondency before eventually settling into “this is useful for some but not all.”
    Ketamine is the most widely used anaesthetic in the world and is on the WHO list of “Essential Medicines” to be stocked at all hospitals. This is because of it’s safety profile due to mimimal effects on respiration and the cardiovascular system. It continues to be used to manage severe pain conditions as well as being widely used in veterinary medicine.

  • It’s good to see reasoned debate on a subject which is highly important to those who have not been helped by current treatments.
    On the issue of placebo effects, although there have been multiple double-blind placebo controlled trials these have mainly used saline as the placebo and it is hard to see people not being able to guess whether they are taking the ketamine. Some are now using midazolam as a placebo which is an improvement but it’s not exactly the same as ketamine in terms of it’s effects. Alcohol [most people taking low dose ketamine describe the experience to be like having a half glass of beer or wine] would possibly be better but this may have it’s own issues.
    The main problem in getting the large-scale trials which would provide more certainty is financial. Because ketamine is long out of patent the pharmaceutical companies have no incentive to invest in new indications for it’s use, so all of the recent studies have been done by poorly funded public facilities who have done very well within their limitations.
    As to dosage and the method of administration, most of the research has followed the initial intravenous protocol of the Berman study from 2000 and it is only recently that there has been a growing effort to look for approaches that are more practical and affordable than IV. There are some promising developments in the use of oral ketamine as evidenced by the work of Angelo De Gioannis who has treated over 600 patients in a clinic setting in Brisbane with results similar to the injection routes – his results are due to be published soon.
    So we are faced with the reality that the evidence we have is not perfect and we have people suffering and dying prematurely from treatment-resistant psychiatric illness. For me the benefits of trialing ketamine as part of a comprehensive treatment plan outweigh the short and long term risks about which we know a great deal, as ketamine has been used for round 50 years now in anesthesia, pain medicine and psychiatry.

  • As Dr Mandel has said there is considerable evidence accumulated over the past 15 years that ketamine is a safe and effective treatment for depression that is not helped by other therapies. Ketamine can be administered by a variety of routes including oral, sublingual, subcutaneous, intramuscular and intravenous.
    Low dose sublingual ketamine is a promising development as it’s use enables all psychiatrists to include it as part of a comprehensive treatment plan. After an initial monitored test dose patients can safely take follow up doses at home.
    It is important to know that although the recreational use of ketamine can lead to tolerance dependence and addiction for some, there are no reports of this occurring with the medically prescribed use of ketamine over the past 50 years.
    Further details can be found in the recently published book “Ketamine for Depression.”