Ketamine helps refractory depression

Discussion in 'Fibromyalgia Main Forum' started by victoria, Feb 1, 2011.

  1. victoria

    victoria New Member

    I read about this years ago... glad they are doing studies and may bring it to clinical practice. Ketamine with an a/d can help bring about results within 24 hours...

    This is a transcript of a video commentary from MedScape:

    Hi. I'm Dr. David Feifel. I am Professor of Psychiatry at University of California, San Diego (UCSD) and Director of the Neuropsychiatry and Behavioral Medicine Program at the UCSD Medical Center.

    Today I want to talk about some exciting positive developments in the treatment of depression, especially for depression in our most difficult-to-treat patients. What I really want to talk about is ketamine.

    You may have heard of ketamine -- it's not a new or novel medication. It has been around for many decades. Ketamine is approved as an anesthetic, and it works through the glutamate system.[1]

    A lot of research over the years suggests that glutamate plays an important role in regulating depression, but it has only been in the last few years that people have started to test this concept by actually doing clinical trials with ketamine to see how it may benefit people who have difficult-to-treat depression.

    The results are very exciting in several studies, and most seminally in a study by a group led by Carl Zarate out of the National Institutes of Health.[2] When they conducted a placebo-controlled study looking at intravenous ketamine (and these are small doses of ketamine, very safe), a large percentage of treatment-resistant patients improved -- up to 70% of the patients responded.

    What is really exciting is that the response was very rapid. Response was often within 24 hours, and many patients actually responded within a couple of hours. This is not something we are used to seeing in this difficult-to-treat population, and I think it's very exciting.

    The big problem with intravenous ketamine is that the benefits of a single infusion are not sustained. So in the Zarate study, 35% of the patients did maintain some benefit a week after treatment, but most of the patients relapsed, and eventually all patients, we believe, will relapse after a single infusion.

    So we need to work out how to sustain that benefit in patients who do get a response. However, people are working on it, and there are some interesting protocols for multiple infusions over a series of weeks, similar to what we do with electroconvulsive therapy, for example, and that may solve this problem.

    Is ketamine ready for prime time? It's very close to being ready for prime time. These are approved medications; they are very safe. Ketamine is used many times a day in this very institution, at UCSD Medical Center. We have a population of patients who have no other option; they are extremely ill, their lives are miserable; they have tried everything.

    For that reason, weighing the risks and benefits, we have actually begun a protocol here at UCSD Medical Center where we offer intravenous ketamine infusions for patients in this situation, making it clear to them that this is not an approved medication, that this is not going to be covered by insurance, but that it could be very beneficial for them. ... Keep an eye on intravenous ketamine; I think it could potentially be a real game changer in our field.

    I want to briefly mention another medication that is showing similar, not as extensive, but still promising results, and that is intravenous scopolamine. Scopolamine is not a new drug; it has been around for a long time and was also used as part of a cocktail for anesthesia. Scopolamine is an anticholinergic medication, and a couple of placebo-controlled studies show rapid and very robust improvements in treatment-resistant patients.

    Therefore, intravenous ketamine and intravenous scopolamine might be what we need to treat these difficult patients. Keep an eye on these drugs. We are starting to use scopolamine here at USCD Medical Center, so let's keep our fingers crossed.
  2. gapsych

    gapsych New Member

    I think I am missing something. I don't remember this being mentioned in the thread about Dr. Susser. Dr. Susser is an alternative doc. and the doc in this thread has university affiliations which would put him in a different league.

    I heard about this a long time ago so it's nice to get an update. Hopefully future trials will be forthcoming.


    [This Message was Edited on 02/01/2011]
  3. gapsych

    gapsych New Member

    Thanks, I thought I just couldn't find it.

  4. AuntTammie

    AuntTammie New Member

    is also known as Special's commonly used as a horse tranquilizer and also frequently sold illegally as a street drug....very strong, pretty scary drug.....but then depression can be very strong and pretty scary, too

    the other drug mentioned, scopolamine, is nicknamed the zombie drug because people on it appear fine, but are actually basically zombies - it's often used by criminals because it renders people so compliant they will actually help the criminals commit the crimes against themselves (people have been known to help criminals rob their houses and bank accounts, even give up their own children to kidnappers, etc.....this is another date rape drug, too, becasue of the aforementioned, as well as the fact that it blocks the person on it from forming any memories while they are high)

    again, I am not saying that it is better or worse than really bad intractable depression....just mentioning how it has mainly been used (also I don't know anything about the amounts used in any case)

    if scolpolamine gets approved, it will really make the lack of approval for xyrem seem suspect since the reasoning behind not approving xyrem is pretty much the potential for use as a date rape drug
  5. victoria

    victoria New Member

    From what I understand, they're giving it by i.v. or shots, which should keep it off the streets. Plus, the amounts given should not produce those effects, thankfully.