Ketamine vs Depression

April 3, 2014 1:00 AM

Short BBC report about a small study where people with depression were given small doses of ketamine: "A team at Oxford Health NHS Foundation Trust gave patients doses of ketamine over 40 minutes on up to six occasions. Eight showed improvements in reported levels of depression, with four of them improving so much they were no longer classed as depressed. Some responded within six hours of the first infusion of ketamine. Lead researcher Dr Rupert McShane said: "It really is dramatic for some people, it's the sort of thing really that makes it worth doing psychiatry, it's a really wonderful thing to see. He added: "[The patients] say 'ah this is how I used to think' and the relatives say 'we've got x back'.""
posted by marienbad (32 comments total)

There are also some serious side-effects including one case of the supply of blood to the brain being interrupted.

That does sound serious.
posted by Pruitt-Igoe at 1:52 AM on April 3, 2014 [19 favorites]

At least you won't be depressed about it.
posted by Gyan at 2:09 AM on April 3, 2014 [15 favorites]

It's a reset button. But sometimes, you crash on the way down, other times, you crash on the way back up. Most of the time, the vast majority of the time, it works.

So, are you depressed enough to spin the little cylind...er, try the drug hit reset?
posted by Goofyy at 2:22 AM on April 3, 2014

"What restricts it is the potential for disturbing psychological adverse effects and the route by which is given - intravenous - does restrict it to a small number of people."

I guess insufflation wouldn't give off the right vibe for a medical setting, but that's how club kids do it.
posted by empath at 2:49 AM on April 3, 2014

Text of article: Ketamine infusions for treatment resistant depression: a series of 28 patients treated weekly or twice weekly in an ECT clinic, Journal Psychopharmacology

A cautionary note from the article itself:

The limitations of this study are the lack of a control group and the open label nature of the trial. The design of our study means that the possibility that our results could be explained by a placebo effect was not addressed. There is no substitute for well controlled, randomised studies with careful attention to longer term outcomes and the timing of acute and sub-acute relapse rates. The heterogeneity of patients and of concurrent medication enhances generalisability, but reduces confidence in any of the conclusions.

An earlier discusson: Ketamine for Depression: Where Do We Go from Here?, Marije aan het Rot, et al., Biological Psychiatry.
posted by nangar at 4:14 AM on April 3, 2014 [4 favorites]

I wonder if other disassociatives like laughing gas or pcp would have a similar effect?
posted by empath at 4:20 AM on April 3, 2014

I've seen some interesting research on ketamine being very useful for a subset of people with bipolar depression, too.

I am extraordinarily lucky that my battles with unipolar depression have responded very well to medication. Seeing what the loved ones in my life go through with forms of uni- and bipolar depression that are quite medication-resistant to the options we have now make me very glad people are out there doing this research.
posted by Stacey at 5:24 AM on April 3, 2014 [1 favorite]

> I wonder if other disassociatives like laughing gas or pcp would have a similar effect?

I had anaesthesia for knee surgery some 16 years ago, and coming out of the anaesthesia was exactly like hitting reset - you really feel 'out' of any rut, the world was brand-new. and the effect can be long-lasting, especially if you can recall at will what that felt like at the time.
posted by Artful Codger at 5:31 AM on April 3, 2014 [1 favorite]

Not so odd that the drugs people use to self-medicate can actually have real medical effects, is it?
posted by edheil at 5:53 AM on April 3, 2014 [19 favorites]

What is the usual anaesthetic they give you for surgery? I had maxillofacial surgery a few years ago and when i woke up, aside from a monster hunger and thirst I was so depressed, I asked my doctors to put me under again (request denied). Because I was so depressed.
posted by evil_esto at 5:54 AM on April 3, 2014 [2 favorites]

This was meant to be a gonzo account, which didn't work out, but at least my probably only ever mefi post is on a US study about it (2010, with rats, not humans).

Around the time I reluctantly let some friends feed me a small dose, just at their house, watching cartoons. They'd told me at a certain dose it might be like going into a well, by oneself, and could be a nice feeling if one was prepared for it. I was a fan of Murakami's Wind Up Bird where the character camps out in a dried up well to visit the collective unconscious and I was not averse.
Soon I noticed a small struggle between remaining with the social situation, understanding the cartoon and laughing in appropriate places and making eye contact, and looking into myself at this interesting thing that was happening. A pressure I now know was hypervigilance from having been bullied for years and so burnt in that I'd forgotten it was there. It'd never even occurred to me up to that moment that maybe sometimes I could allow myself to let my guard down around friends. Doing it was like relaxing muscles that'd been tense for a decade or so.
I wouldn't say it was anyting like in Murakami's book, and it's hard to talk about it without sounding completely delusional. To me it was like finding a place where time has little to no meaning, "a very old place". I couldn't describe it any better. It seemed familiar. I used to listen to Bach's cello suite in Eb major and it is in there too. tl;dr against that scale even decades of depression just seem to shrink into perspective, and anybody who has experienced depression knows it normally doesn't do perspective.

Sadly, it is so extremely unsuitable for self medication. Anyone I witnessed during that time doing it more than occasionally had a volatile and short career due to the tolerance curve and addictiveness. For that same reason I never tried to find steady sources. I value the insights it's given me and the delusions it's warned me with. Last but not least, combining it with Valium is really ill advised if one values their respiratory function.
posted by yoHighness at 5:58 AM on April 3, 2014 [13 favorites]

So, in general, how does one go about getting it..?
posted by dobie at 6:28 AM on April 3, 2014 [2 favorites]

I wonder if other disassociatives like laughing gas or pcp would have a similar effect?

There is some speculation that dextromethorphan (also a dissociative, and the active ingredient in cough syrup) may act as an antidepressant.
posted by logicpunk at 6:39 AM on April 3, 2014

I don't know if it mentions it in the articles, but when some of these studies were being released, one of the most amazing and important things, I think, when it comes to depression, apart from the resetting of the depression is that it has been show to be really damn effective at suppressing suicidal thoughts RIGHT AWAY. That is, it can act as a prophylactic against suicide if one is feeling suicidal while it works on the general depression effects as well, and add in therapy and there is now reason we shouldn't be using this when it's needed.

Our anti-drug hysteria has really damaged the potential for psychoactive-assisted therapy. And no, SSRI's and MAOI's do not count. I'm talking about the kind that really fucking get in deep and can help, like MDMA, Psilocybin, Ketamine, LSD and Ayahuasca (the latter two I would be a bit more judicious in usage).
posted by symbioid at 6:44 AM on April 3, 2014 [16 favorites]

I've never used ketamine, but I absolutely credit the couple of times I tried psilocybin in college with a major turning point in my depression and anxiety. Even though the drugs are totally different my experience was similar to yoHighness' - the "very old place" and relaxing psychic muscles I didn't know I had. I wasn't completely free of depressive and anxious tendencies, but for the first time in my life I was able to see my own unhappiness, fear, etc. as something temporary, surmountable, and most importantly separable from my identity. I think it's really tragic that so many suffering people either don't have access to the potential benefits of these drugs, or if they do, they have to break the law, take the risk that what they're buying isn't what they think they're buying, and most importantly conceal their use from their doctors. Good on the teams of researchers who are finally getting some real data.
posted by oinopaponton at 6:55 AM on April 3, 2014 [15 favorites]

Ok, media, you're not helping...

You could have gone with the headline: "Inexpensive Commonly Used Anesthetic Show Promise in Treating Resistant Depression"

But instead I read: "Can Party Drug Make You Happy?"

I'm skeptical as fuck, but am very pro research. One thing we can all agree upon, all newspaper editors are worthless humans who should probably disappear down some kind of dark, confusing hole.
posted by Slarty Bartfast at 7:02 AM on April 3, 2014 [1 favorite]

No, we can't agree on that.
posted by agregoli at 7:29 AM on April 3, 2014 [4 favorites]

In the early 70's I fell in with this group of fast friends, some of them doctors, who were into some exotic recreational drugs, including ketamine. One of them really really wanted to share this experience with me.

The drill was to inject one another with this, and then just lay on a bed, because apparently ketamine takes away consciousness of one's body, so one becomes, for the time the drug is active, just a mind floating in space.

So one night this doc and another friend and I were in the doc's apartment, and it was time to do this. At the last minute, I got cold feet and declined. The other two guys were really bummed and implored me to share in this with them. I became more and more sure that I did not want to do this (possibly due to it being injected into a vein, just because paralysis lost its appeal to me at that point) so I just hung out in the living room while they were tripping on the bed.

I still consider this one of the best decisions I have ever made. It was before HIV was known, and there was a bit of bisexual play in this group, so with needles, well, one never knows.

The next day, the doc apologized for pressuring me, and I said it was fine. . .he came over at some time later and left two syringes with ketamine in them in my fridge, just in case I got the urge. I never did, and eventually another doc in this group used them.
posted by Danf at 8:14 AM on April 3, 2014

"Party drug could help treat severe depression" - Times of India

I'm trying to figure out if going under for various surgeries had a 'reboot' effect on me. I know I talk a lot when I come out, which amuses the nurses. I may be having another soon, and not sure if reading this will have a placebo effect on the outcome.
posted by tilde at 8:21 AM on April 3, 2014

This sort of research really fascinates me, particularly when you get into drugs like LSD or psylocibin where one dose can result in an experience that alters life for a long time.

I feel like anything that has long-lasting effects will now be penalized/dismissed/tarred, though, because there's a lot of money in treating people for chronic illnesses, including chronic depression, and if you can cure someone, or manage their illness, with a shot of a drug so old it's got to be off patent and generic every three months, where's the money in that? And as (particularly in the US) basic research funding vanishes and research is sponsored by companies looking for ROI, there's zero incentive for research to prove what these drugs can do, and a lot of incentive to "prove" that they're dangerous and should be classified with Bad Drugs we are At War With.
posted by immlass at 8:28 AM on April 3, 2014 [6 favorites]

> I wonder if other disassociatives like laughing gas or pcp would have a similar effect?

LSD

I feel like anything that has long-lasting effects will now be penalized/dismissed/tarred, though, because there's a lot of money in treating people for chronic illnesses, including chronic depression, and if you can cure someone, or manage their illness, with a shot of a drug so old it's got to be off patent and generic every three months, where's the money in that?

See also: fasting. No money in not eating. Why the fuck should we research that?
posted by mrgrimm at 10:40 AM on April 3, 2014 [1 favorite]

At this point it just makes me sad when any sort of recreational drug shows any promise as an actual pharmaceutical, because the uphill climb is nearly impossible.

I accidentally rebooted myself out of a serious multi-year depressive run with hallucinogens in my 20s. It was absolutely a chemical change, not a profound trip or whatever - my sleep disorders went away for years, as did the low-level constant aches and pains and my ocular migraines. But it would be almost impossible for even the most willing neurologists to get a study on mescaline or LSD past a human subjects review board.

(I am also unwilling to do it again because I'm old and no longer interested in taking unknown substances purchased from some random guy my friend's roommate's cousin knows. I want to pick up my regulated trip from a pharmacy, thank you very much.)

I suspect that if we found out tomorrow that a specific preparation of cocaine cured cancer, it'd be another 20 years before it became an official treatment, just because cocaine.
posted by Lyn Never at 11:04 AM on April 3, 2014 [3 favorites]

Thanks for that link, mrgrimm. Most of the time I've come across the idea of fasting it's been for weight loss, radical lifestyle change, and more. That specific article, however, makes me think that one might be able to fiddle with it to reboot insomnia.

There is more research out there than one might expect, though.

There is indeed a large body of research to support the health benefits of fasting, though most of it has been conducted on animals, not humans. Still, the results have been promising. Fasting has been shown to improve biomarkers of disease, reduce oxidative stress and preserve learning and memory functioning, according to Mark Mattson, senior investigator for the National Institute on Aging, part of the US National Institutes of Health. Mattson has investigated the health benefits of intermittent fasting on the cardiovascular system and brain in rodents, and has called for “well-controlled human studies” in people “across a range of body mass indexes” (J Nutr Biochem 2005;16:129-37).

Sorry for the detour ...
posted by tilde at 11:41 AM on April 3, 2014 [2 favorites]

That does sound serious.

How about 1) catastrophic, 2) disastrous, 3) fatal being less euphemistic diction they could have utilized.
posted by polymodus at 1:33 PM on April 3, 2014

Our anti-drug hysteria has really damaged the potential for psychoactive-assisted therapy. And no, SSRI's and MAOI's do not count. I'm talking about the kind that really fucking get in deep and can help, like MDMA, Psilocybin, Ketamine, LSD and Ayahuasca (the latter two I would be a bit more judicious in usage).

A good trip: Researchers are giving psychedelics to cancer patients to help alleviate their despair — and it's working
posted by homunculus at 2:11 PM on April 3, 2014 [3 favorites]

So, in general, how does one go about getting it..?

Be very good friends with a veterinarian or a pediatric nurse.
posted by empath at 4:10 PM on April 3, 2014

There is so much interesting work on using psychedelics in psychotherapy therapy by the MAPS Project and others, ala Miss Molly Goes to War.

As a rule, these drugs work by aiding psychotherapy rather than by acting like medicines in the classical sense, so talk to folks running trials if you think you might benefit from the treatment. Do not just self-medicate.

That said, this ketamine business sounds more like "just take this pill" than all the psychedelic treatments do.
posted by jeffburdges at 4:24 PM on April 3, 2014 [3 favorites]

There is some speculation that dextromethorphan (also a dissociative, and the active ingredient in cough syrup) may act as an antidepressant.

Anecdotal: a friend has spent a few years invested in researched and rationalized self-medication with high doses of dextromethorphan and insists it provides relief from lifelong depression that other treatments cannot. The side effect being that the rest of his life has since been in impressive and uninterrupted turmoil, and many babies have been irretrievably discarded with the bathwater.

This non-rigorous sample of one indicates dxm might be a profound if exceptionally "noisy" method of therapy. Another friend is likewise exhibiting complications from a dxm habit.

Not to rule it out of potential for clinical research, or any other application really, just noting that it should probably not be considered lightly.
posted by methinks at 10:35 PM on April 3, 2014

You know how in a cartoon, where a character is dazed/dizzy/drunk/etc, they get this expression with a big silly grin and swirling spirals for eyes?

That's pretty much exactly how it was for me. Nothing deep or complicated, just... "Heh. Heheh. Duhoy!"

Anyway, always good to hear when these kind of things turn out to also have serious, worthwhile effects when used 'properly'.
posted by Drexen at 7:04 AM on April 4, 2014

And if you absolutely must self-medicate with strong recreational substances then do so either with experienced and close friends or family in a familiar, friendly, and happy environment. Any drug that helps fix psychological problems by opening a door for treatment could also make said psychological problems worse if you take it at the club only to spend the evening watching a friend get beaten up, you love interest get hit on, etc.
posted by jeffburdges at 7:33 AM on April 4, 2014

So, in general, how does one go about getting it..?

Find your local raver or club kid. Or a veterinarian or anesthesiologist (ketamine is very commonly used as anaesthesia induction. It's also very common treatment for severe burn victims because of the dissociative properties.)

For a period in my 20s I did a lot of K. I mean a lot. My boyfriend and I would go through it like some people go through cocaine. I mean seriously, we'd buy a couple 8-balls on Friday and they'd be gone by Sunday afternoon.

It's also the only time in my life I can remember not being depressed. I eventually kicked it because I was scared of the addictive qualities, and the recovery afterward was really nasty. Even now on high doses of a very effective antidepressant I'm still depressed, and tried to commit suicide last week. On K? That never happened. The thought never entered my mind.
posted by feckless fecal fear mongering at 9:05 AM on April 4, 2014 [2 favorites]

The Doctored Results of the Concord Prison Study
posted by homunculus at 3:30 PM on April 20, 2014 [1 favorite]