Health
Study Finds Low-Cost Ketamine Effective in Some Patients with Severe Drug-Resistant Depression
A cheaper version of ketamine, commonly used as a sedative, may help some people with hard-to-treat depression, a new study finds, making it more effective for those who need off-label treatment. Hopes are high that it could be cheaper.
Key Point:
- A study of about 180 patients examined whether generic ketamine could improve severe depression
- Twenty percent of participants reported symptom relief when treated with ketamine, compared with only 2 percent on placebo.
- Professional stress ketamine should only be administered by a trained health care professional
Researchers in Australia and New Zealand have begun investigating whether a generic version of ketamine can help alleviate depression that has resisted other treatments.
About two-thirds of people with depression will not succeed with the first treatment they try, according to Harvard University.
Patients treated with generic ketamine were 10 times more likely to see improvement in symptoms when compared to placebo, according to a study published today in the British Journal of Psychiatry.
Colleen Lu, professor of psychiatry in New South Wales, one of the experts involved in the study, said it was a “huge difference”.
In addition, ketamine appears to be effective in “treatment-resistant” depressed patients who have failed multiple other treatments.
Researchers hope the latest research will lead to cheaper treatments for mental health patients who have virtually exhausted all other options.
“There’s a patented version of ketamine recently approved by the TGA that’s about 40 times more expensive,” said Anthony Rogers, a public health and clinical trials expert at The George Institute.
What did the research include?
Approximately 180 people participated in the double-blind placebo trial, which meant that participants did not know whether they had been given ketamine.
Participants received two injections per week for a month, then were followed up by researchers to see how their depression was being tracked.
A barium-based drug was used as a placebo, making it difficult for participants to tell if they received the real thing.
The results were significant.
Twenty percent of ketamine users went into complete remission, compared with only 2 percent of placebo users.
And Prof. Lu said a 20 percent success rate might not be a big deal, but it’s the scale of the improvement that counts.
“If you look at some other studies on ketamine, they may report results of, say, 50 percent remission. [with] It was 30 percent with ketamine and placebo,” she said.
“It’s not the absolute number that counts… it’s the comparison that counts.”
Why is ketamine used for depression?
More than two decades ago, a study serendipitously showed that ketamine could have “transformative effects” in people with severe depression, said Rogers.
Since then, multiple other studies have provided strong evidence that ketamine may help some people.
“Looking back now… one of the big things we think is why it took 20 years,” he said.
But experts stress that ketamine should only be considered with a trained mental health professional if many other options have failed.
First-line antidepressants such as SSRIs, psychological support, lifestyle changes, and other medications can all be used to treat depression.
“It’s only after these stages that the symptoms haven’t improved, and it looks like I have depression with a significant biological component… I’m considering something like ketamine.” said Professor Lou.
In this particular study, the researchers focused on patients with “treatment-resistant” depression. Patients were defined as severely depressed patients who had failed at least two previous treatments.
About a quarter of the study participants had previously undergone ECT (electroconvulsive therapy), a treatment that sends electrical currents to the brain, essentially waking them out of depression, but that did not relieve their symptoms.
Does this mean I can take ketamine to treat depression?
You shouldn’t try this at home.
Professor Lou said ketamine is a powerful drug with complex actions.
Some patients go from “severe depression to full well” within a day, but it can also have the opposite effect.
“It’s not just depression, it’s suicidal, so it needs to be managed and monitored very carefully,” she says.
“I don’t think this is something people do in an office or a regular doctor’s office.
“I think we need professional treatment by people with specific expertise.”
What’s new in this research?
We already knew that ketamine could be used for some types of depression.
Scientists are still trying to understand practical questions such as who will benefit most from treatment, how to use it most effectively, and what treatments are best.
University of South Australia researcher Michael Musker, who was not involved in the trial, said the study “shows promising results for people with difficult-to-treat conditions.”
But it’s unclear whether the benefits will last long-term, he said. I wrote to The Conversation.
“Four weeks after the end of treatment, there was limited sustained improvement in symptoms in the ketamine group,” he said. “This suggests that treatment over a longer period may be required.”
The main takeaway from this new study is that generic ketamine was more effective than placebo. This is important as most of the research so far has focused on branded versions.
But Prof Lu said the study made several other important contributions to what scientists know about ketamine.
- adjust Dosage based on the patient’s response to the drug may be effective. Previously, most studies gave patients standard weight-based doses.
- to manage Generic ketamine by injection similar to what diabetics use to inject insulin was effective. Generic ketamine is usually given by infusion.
- it was Effective for depression, which is very difficult to treat. Previous studies have not included such strong criteria for ‘treatment resistance’. The more “treatment resistant” depression, the less likely advanced treatments such as ECT and ketamine will work.
what’s next?
Experts hope that patients who benefit from ketamine will be able to access cheaper treatments.
“The next challenge is, now that we know this, [generic] The treatment is effective, recommended by RANZCP, and accessible for patients,” said Professor Rogers.
“The cost of the drug itself is very cheap, but the service cost of administering it is not.”
After administering ketamine, patients should be monitored by a healthcare professional for several hours afterwards to watch for any negative side effects. This effort can cost ketamine treatment hundreds of dollars.
“We very much hope that a Medicare Code will soon be created to support its use and affordable access,” he said.
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