Ketamine, the horse tranquilizer, known as a party-drug and for its hallucinogenic effects, has been found to be an effective and exciting new treatment for severe cases of depression.
The drug, which is illegal, although much used at weekends and in nightclubs on the black market, was tested on patients with “incurable” severe depression who saw results within hours. The results were indicated in a small trial of 28 people and are published today in the Journal of Psychopharmacology.
Depression, the “invisible illness” affects as many as one in every ten at some point in their lifetime, and is a horrendously difficult condition to try to live with. Treatments include the use of antidepressants and behaviour or “talking” therapies but some do not respond to these and continue to struggle.
The Oxford NHS Foundation found that eight of their test group reported improvements in their symptoms after being given a dose of ketamine every 40 minutes over six trials. Four improved so much they were no longer classified as “depressed.” The findings also showed the benefits ongoing for up to eight months afterwards, with the median being 2.3 months. Some responded so quickly they were felling better within hours of the first infusion.
Dr Rupert McShane, who led the research, described the study as “dramatic” and a “really wonderful thing to see.” He told how patients were saying “Ah, this is how I used to feel,” and their friends and relatives delightedly adding, “we’ve got x back.” Some members of the test group had been suffering for 20 years.
Although the results are highly promising, he cautions that they open up a new avenue for research and are not about to become an instant replacement for prozac. Not all the findings were positive. Ketamine is renowned for causing bad side effects with the bladder, and while this was not caused, nor cognitive problems; anxiety and nausea were. One patient in the trial experienced a loss of blood supply to the brain and fainted. Others went into relapse after only a few days.
The professor of psychopharmacology at Kings College London said the study shows that depression is chemical, and that it dissipates forever the myth that depressed people show somehow “get a grip” or “pull their socks up” the common misunderstandings that plague the victims. David Taylor hopes in the future to see a chemical developed that can be taken by means of an inhaler. The means of administering the ketamine in this experiment, intravenously, and the possible side-effects, make it of restricted application at this stage.
Taylor was impressed with the “spontaneous remission” results and told reporters that “this almost never happens” in cases where long-term depressives are at the end of the line and have tried everything.
Ketamine is about to be upgraded to a class B (banned) drug in the United Kingdom because of growing concerns about its psychological and physical effects. Some young people who have used it in dance clubs have ended up having to have their bladders removed. It is already used in medical practice as an anaesthetic and for treating back pain.
The Oxford team are continuing their work and are now trialling 45 patients and trying to find ways to prolong the improvements. Dr McShane says, “Its very moving to witness.” He is seeing people whom no other treatment has ever helped before suddenly finding that “the flow of their thinking seems suddenly clearer.”
Previously, the last resort option for treatment resistant depressives has been electroconvulsive therapy (ECT) which carries a risk of memory loss. New treatment options have long been needed.
The ketamine infusions did not make the patients feel euphoric as is its reputation as a party drug. The doses used in the study were much lower than those typically sold on the street for recreational use, only 80 thousandth of a gram per infusion. They were also administered under tightly controlled and safe conditions in a hospital unit. There is no evidence of addiction in any of the participants, some of whom have now been involved for two years of testing.
Dr McShane notes that ketamine is an inexpensive drug and his hopes are to find a “simple way” to “prolong its dramatic effect.” With this goal, the lives of those blighted by chronic and severe depression could, in future, be radically improved.
By Kate Henderson