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Ketamine For Severe Depression:'How Do You Not Offer This Drug ToPeople?'
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March 20, 2017 · 3:19 PM ET
Heard on All Things Considered
JON HAMILTON
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Gerard Sanacora, a professor of psychiatry at Yale University, has treatedhundreds of severely depressed patients with low doses of ketamine, ananesthetic and popular club drug that isn't approved for depression.
This sort of "off-label" prescribing is legal. But Sanacora says otherdoctors sometimes ask him, "How can you be offering this to patientsbased on the limited amount of information that's out there and notknowing the potential long-term risk?"
Sanacora has a simple answer.
"If you have patients that are likely to seriously injure themselves or killthemselves within a short period of time, and they've tried the standardtreatments, how do you not offer this treatment?" he says.
More and more doctors seem to agree with Sanacora.
From TheArchives
Dozens of clinics now offer ketamine topatients with depression. And a survey ofproviders in the U.S. and Canada showed that"well over 3,000" patients have been treatedso far, Sanacora says.
A number of small studies have found thatketamine can do something no other drugcan: it often relieves even suicidal depressionin a matter of hours in patients who have notresponded to other treatments.
Ketamine's potential as an antidepressant wasrecognized more than a decade ago. Andstudies done since then provide "compellingevidence that the antidepressant effects ofketamine infusion are both rapid and robust,albeit transient," according to a consensusstatement from a task force of the AmericanPsychiatric Association. Sanacora is one of thetask force members.
But there are still a lot of unanswered questions about ketamine, saysJames Murrough, an assistant professor of psychiatry and neuroscienceat the Icahn School of Medicine at Mt. Sinai in New York.
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"We haven't had large-scale trials. We don't know how much or how oftenit should be given for it to be effective or safe," says Murrough, who is anauthor of a review of ketamine published in the journal Nature ReviewsDrug Discovery.
Doctors know a lot about the short-term effects of ketamine because ithas been used as an anesthetic in emergency rooms for decades. Butthere's still not much information about the effects of using ketamine foryears.
A vial of ketamine, an anesthetic and club drug that is sometimes used to treat severe depression.Wikipedia
That's worrisome because ketamine's antidepressant effect tends to wearoff after a few days or weeks, meaning patients need repeated infusions tokeep depression at bay, Murrough says.
Still, Murrough thinks the case for using ketamine is much stronger than
it was just a few years ago.
"There's warranted caution that's balanced with an optimism that sayswe've never had a new medication for depression since the era of Prozac,"Murrough says.
Prozac arrived in the 1980s, and became the first of a new class ofdepression drugs that target the neurotransmitter serotonin.
Ketamine acts on a different neurotransmitter called glutamate. Thedrug's success has pharmaceutical companies excited about the possibilityof creating a whole new class of drugs for depression, Murrough says.
"Companies are reopening programs," he says. "They are pulling [old]drugs off the shelf that they know act on the glutamate system."
One promising candidate is a chemical sibling of ketamine calledesketamine. It's now in the final phase of testing before consideration bythe Food and Drug Administration, which designated esketamine as abreakthrough therapy.
And esketamine is just one of several ketamine-like drugs indevelopment, says Sanacora, who consults for companies developingthese drugs.
"This is probably the most interesting and exciting new development thatI've seen in my career, and probably going back over the past 50 to 60years," he says.
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