Depression: What We Know About Ketamine Safety Research

The global number of people affected by varying levels of depression has blown up over the past couple of decades. According to the World Health Organization, that number currently sits at well over 300-million. With many cases of depression growing resistant to the most common types of treatment, there is a growing necessity to find a rapid-acting treatment for this epidemic.

There is growing evidence that appears to demonstrate the efficacy of an anesthetic known as ketamine in the treatment of varying levels and expressions of depression. Studies thus far have proven ketamine as the potential source of long-awaited rapid-acting relief for patients experiencing depression. Used in the treatment of pain since the Vietnam War of the 1960s, ketamine has also been used as a tranquilizer for horses and other animals during important operations. Studies surrounding ketamine’s efficacy in the treatment of depression were only first launched in the year 2000, so knowledge on ketamine from this perspective is very much a new thing. And this does lead many people to ask the question: just what do we know about the safety of ketamine in the treatment of depression?

A Bold Step, Or A Dangerous One?

Given all the highly promising evidence surrounding ketamine and depression, more and more clinics around the world are starting to offer treatments. From Canada and the USA to the UK, Australia and New Zealand, patients are now able to step into a clinic and receive ketamine treatments for depression, which generally last around 20 minutes. And that’s it, a 20-minute intravenous (or intranasal, or intramuscular) treatment, depressive and dark feelings subsided, and patient’s are able to return to the world and carry on with their days.

This is a very bold move by the clinics in question, and many patients are highly satisfied with their experiences of the treatment. However, as mentioned above, all the findings surrounding ketamine for the treatment of depression are very new – less than 20 years old. And some medical researchers/professionals feel much more skeptical towards the potential of a mass-adoption of ketamine treatments for depression worldwide, at least in the short-term. They argue that much more consideration must be given to the potential side-effects of this solution over the long-term, especially when considering its repeated use for the purposes in question.

Working For the Long-Term, Not The Short-Term

Professor Colleen Loo is a psychiatrist and clinical academic based at St George Hospital and the Black Dog Institute. She is also Medical Director of the electroconvulsive therapy (ECT) service at Wesley Hospital Kogarah. Together with her team at the University of New South Wales, Prof. Loo has been carrying out in-depth clinical studies of ketamine in its capacity to efficaciously treat symptoms of depression.

 

 

Loo considers those clinics now offering ketamine as a valid treatment for depression as experimental and dubiously-legal. And she argues that, in a similar capacity to her team, the wider medical community should be putting much more time and energy into ketamine research. Very few existing studies effectively report on the safety of repeated doses or the sustained use of ketamine, and this is a gap that Prof. Loo and her team are aiming to fill. But long-term studies happen over the long-term, and some patients’ impatience and/or quest for convenience is something that appears quite worrying for Prof. Loo, whose clinical studies require patients to traverse an extensive several-hour-long questionnaire. Loo says, “Some patients think, ‘Why bother going to a research study, I might as well just go to these clinics for 20 minutes rather than answering questions for four hours before treatment.’ But the reason we do that is that the majority of our time is spent addressing safety issues”.

Documented Side Effects Thus Far; Simply Not Enough

In their study of the available medical literature on the topic of ketamine for depression, Prof. Loo and her team discovered and analysed a total of 288 articles, of which 60 studies met the inclusion criteria for their research endeavours. These studies encompassed a total of 899 patients, each who had received at least one dose of ketamine. What they found was that intravenously-administered ketamine creates more dissociative side effects than ketamine administered subcutaneously via a tiny needle, similar to those used by diabetics in the administration of insulin. It’s quite some difference: 36 percent of non-intravenous patient groups reported dissociative side-effects, compared to 72 percent of patients from intravenous ketamine studies.

What the team also discovered from the available medical literature was that the other most common side effects included dizziness, elevated blood pressure and blurred vision. These side-effects match those reported by other pre-existing user groups – namely recreational drug users or those using ketamine as a treatment for chronic pain. However, the grand majority of studies researched by Loo and her team were inconclusive in terms of data pertaining to ketamine’s longer-term or cumulative effects. “Despite low ketamine doses currently being used in depression studies, urological toxicity, liver function abnormalities, negative cognitive effects and risk of dependency may limit the safe use of ketamine as a long-term antidepressant treatment”, Prof. Loo’s team stated. It would appear that this team of researchers at the Black Dog Institute have a very strong and valid grounding to their approach.

A Sustainable Approach That Helps Everybody

There are many people in the world who believe that ketamine could be the immediate answer to those who are so severely debilitated by the ferocious global epidemic that is depression, that they have become almost completely disabled. There exists a belief that, for these people, since they are incapable of taking any other positive action towards the treatment and/or relief and/or remission of their depressive symptoms, ketamine could be their immediate first step towards a more positively-lead life. It changes the brain chemistry and thus a person’s mood states. And a change in mood state may be considered the fundamental base for getting up, getting out and engaging in other, more positive, activities – such as eating healthy, meditating or exercising.

This approach may well be true, but instead of – or perhaps as a complement to – taking the short-term route and receiving short, rapid treatments for rapid symptomatic relief, there is a clear argument for affected patients to actively participate in clinical studies, such as the research of Prof. Loo and her team. This may not only provide short-term symptomatic relief on an ongoing basis, but it may very well contribute to the wider medical world, and indeed the global public at large, by establishing ketamine as a clinically verified, stable and safe treatment for even the most severe cases of depression.