X owner Elon Musk recently described using small amounts of ketamine “once every other week” to administer the “chemical tides” that cause his depression. He says it’s helpful to get out of a “negative way of thinking”.
This has caused a spread of reactions within the media, including on X (formerly Twitter), from strong support for Musk’s selection of treatment, to allegations he has a drug problem.
But what exactly is ketamine? And what’s its role within the treatment of depression?
It was first used as an anaesthetic
Ketamine is a dissociative anaesthetic utilized in surgery and to alleviate pain.
At certain doses, individuals are awake but are disconnected from their bodies. This makes it useful for paramedics, for instance, who can proceed to confer with injured patients while the drug blocks pain but without affecting the person’s respiratory or blood flow.
Ketamine can also be used to sedate animals in veterinary practice.
Ketamine is a mix of two molecules, often referred to a S-Ketamine and R-Ketamine.
S-Ketamine, or esketamine, is stronger than R-Ketamine and was approved in 2019 within the United States under the drug name Spravato for serious and long-term depression that has not responded to no less than two other sorts of treatments.
Ketamine is assumed to change chemicals within the brain that affect mood.
While the precise way ketamine works on the brain will not be known, scientists think it changes the quantity of the neurotransmitter glutamate and due to this fact changes symptoms of depression.
How was it developed?
Ketamine was first synthesised by chemists on the Parke Davis pharmaceutical company in Michigan within the United States as an anaesthetic. It was tested on a bunch of prisoners at Jackson Prison in Michigan in 1964 and located to be fast acting with few unintended effects.
The US Food and Drug Administration approved ketamine as a general anaesthetic in 1970. It is now on the World Health Organization’s core list of essential medicines for health systems worldwide as an anaesthetic drug.
In 1994, following patient reports of improved depression symptoms after surgery where ketamine was used because the anaesthetic, researchers began studying the consequences of low doses of ketamine on depression.
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The first clinical trial results were published in 2000. In the trial, seven people got either intravenous ketamine or a salt solution over two days. Like the sooner case studies, ketamine was found to cut back symptoms of depression quickly, often inside hours and the consequences lasted as much as seven days.
Over the past 20 years, researchers have studied the consequences of ketamine on treatment resistant depression, bipolar disorderpost-traumatic sress disorder obsessive-compulsive disorder, eating disorders and for reducing substance usewith generally positive results.
One study in a community clinic providing ketamine intravenous therapy for depression and anxiety found the vast majority of patients reported improved depression symptoms eight weeks after starting regular treatment.
While this might sound like plenty of research, it’s not. A recent review of randomised controlled trials conducted as much as April 2023 the consequences of ketamine for treating depression found only 49 studies involving a complete of three,299 patients worldwide. In comparison, in 2021 alone, there have been 1,489 studies being conducted on cancer drugs.
Is ketamine prescribed in Australia?
Even though the research results on ketamine’s effectiveness are encouraging, scientists still don’t really know the way it really works. That’s why it’s not available from GPs in Australia as a normal depression treatment. Instead, ketamine is usually utilized in specialised clinics and research centres.
However, the clinical use of ketamine is increasing. Spravato nasal spray was approved by the Australian Therapuetic Goods Administration (TGA) in 2021. It have to be administered under the direct supervision of a health-care skilled, often a psychiatrist.
Spravato dosage and frequency varies for everybody. People often start with three to 6 doses over several weeks to see how it really works, moving to fortnightly treatment as a maintenance dose. The nasal spray costs between A$600 and $900 per dose, which can significantly limit many individuals’s access to the drug.
Ketamine could be prescribed “off-label” by GPs in Australia who can prescribe schedule 8 drugs. This means it’s as much as the GP to evaluate the person and their medication needs. But experts within the drug recommend caution due to lack of research into negative side-effects and longer-term effects.
What about its illicit use?
Concern about use and misuse of ketamine is heightened by highly publicised deaths connected to the drug.
Ketamine has been used as a recreational drug because the Nineteen Seventies. People report it makes them feel euphoric, trance-like, floating and dreamy. However, the amounts used recreationally are typically higher than those used to treat depression.
Information about deaths because of ketamine is proscribed. Those which are reported are because of accidents or ketamine combined with other drugs. No deaths have been reported in treatment settings.
Reducing stigma
Depression is the third leading reason for disability worldwide and effective treatments are needed.
Seeking medical advice about treatment for depression is wiser than taking Musk’s advice on which drugs to make use of.
However, Musk’s public discussion of his mental health challenges and experiences of treatment has the potential to cut back stigma around depression and help-seeking for mental health conditions.
