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CHICAGO (AP) – It was launched several decades ago as an anesthetic for animals and humans. He became a powerful painkiller on the battlefield in Vietnam and became Special K trippling club drug.
The drug for chameleon, ketamine, is new life as an unapproved treatment for depression and depression. suicidal behavior. In the United States, clinics have opened by promising immediate relief with their "single" doses of ketamine in intravenous infusions, aerosols or pills. And desperate patients spend thousands of dollars on treatments that are often not covered by health insurance, with little evidence of long-term benefits and risks.
Lauren Pestikas, a preschool teacher in Chicago, has long struggled with depression and anxiety and has attempted suicide several times before trying ketamine earlier this year.
The price to date is about $ 3,000, but "it's worth it," said the 36-year-old woman.
Pestikas said that she felt much better for a few weeks. treatment, but the effects fade and she struggles to find a way to pay another
For the moment, Ketamine has not received approval from the US Food and Drug Administration to treat depression , although doctors can use it for this purpose.
Ketamine has been around since the 1960s and is widely used as an anesthetic drug during surgery because it does not suppress breathing. Compared with opioids such as morphine, ketamine is not addictive and does not cause breathing problems. And some studies have shown that ketamine can relieve symptoms within hours in the most severe cases
. Its potential effects on depression were discovered during animal experiments conducted in the late 1980s and early 1990s, showing that glutamate, a chemical messenger of the brain, might play a role. in depression, and that drugs like ketamine, which target the glutamate pathway, sometimes act as antidepressants.
Conventional antidepressants like Prozac target serotonin, a different chemical messenger, and usually take weeks to months – a delay that can cause severe depression Patients must sink deeper into despair.
Ketamine's potential for almost immediate relief, if temporary, is what makes it so exciting, said Dr. Jennifer Vande Voort, a psychiatrist at Mayo Clinic, who has been treating patients with depression since February.
There are not many things that produce this kind of effect. What worries me is that he is so excited, "she said.
udies believe that it is very useful and generally safe to provide short-term help to patients who do not have not benefited from anti-depressants.This is equivalent to about one-third of the estimated 300 million people with depression worldwide.
"This has truly revolutionized the world", has changed the view of scientists on how Depression affects the brain and shows that quick relief is possible, said Yale University's Dr. Gerard Sanacora, a psychiatrist who has conducted research or consulted with companies seeking to develop drugs based on ketamine.
But to become a standard treatment for depression, one needs to know much more.
Last year, Sanacora co-authored a report of the working group of the American Psyc hiatric Association on Ketamine Treatment for Mood Disorders, highlighting the benefits, while stating that "major shortcomings" remain in knowledge about long-term effectiveness and safety. Most of the studies were small, carried out in research contexts and not in the real world.
When administered intravenously, ketamine can cause a rapid increase in heart rate and blood pressure, which can be dangerous for some patients. Ketamine can also cause scary hallucinations for some patients.
"There are real concerns," said Sanacora. "We know that this medicine can be abused, so we must be very careful about how it is developed."
Dr. Rahul Khare, a specialist in emergency medicine in Chicago, discovered for the first time, a decade ago, the other potential benefits of ketamine from an anxious and depressed patient that he & # 39; s # He was preparing to calm down to repair a dislocated shoulder repeatedly.
"He said, Doc, give me," recalls Khare,
Khare became intrigued and started earlier this year proposing ketamine for the treatment of severe depression in an outpatient clinic that he opened a few years later, since then, he also joined the American Society for Physiotherapy Physicians, created a year ago, representing about 140 doctors, nurses, psychologists and other users of ketamine for the treatment depression or other unapproved uses.
There are approximately 150 ketamine treatment clinics in the United States, compared to about 20 three years ago, said Dr. Megan Oxley, co-founder.
Khare said the burgeoning field "is like a new frontier" where doctors gather at meetings and compare their notes.He has treated about 50 depressed patients Pestikas are generally desperate for relief after failing to respond to other antidepressants. Some have lost their jobs and relationships because of severe depression, and most find that ketamine allows them to function, Khare said.
The usual treatment at his clinic consists of six 45-minute sessions over approximately two weeks at a cost of $ 550 each. Some insurers will pay about half of it, covering the cost of visiting Khare's office. Patients may receive "booster" treatments. They must sign a four-page consent form stating that the benefits may not be sustainable, listing potential side effects, and in bold, the treatment is not approved by the government.
In a recent session, the seventh of Pestikas, she leaned back on a reclining white chair while a nurse was hooking her up to a heart monitor and a blood pressure monitor. She grimaced when a needle slipped into the palm of her left hand. Khare raised her hand with a syringe to inject a small dose of ketamine into an infusion bag hanging over the chair, then lowered the light, pulled the curtains out of the window and asked if she had any questions and if she was feeling well. .
"No questions, just grateful," Pestikas replied with a smile.
Pestikas listened to music on his iPhone and watched psychedelic videos. She said it was like "a controlled acid trip" with pleasant hallucinations. The trip ends shortly after the withdrawal of the infusion, but Pestikas said that she felt calm and relaxed the rest of the day and that the mood rush could last for weeks.
Studies suggest that a single dose of ketamine by intravenous infusion is much smaller than that used for sedation or feasting can help many patients get relief in about four hours and for nearly a year. one week
. It's unclear exactly how ketamine works, but one idea is that by raising glutamate levels, ketamine helps nerve cells to restore connections have been disabled by depression, said Dr. Carlos Zarate, expert in ketamine , responsible for experimental therapies at the National Institute of Mental Health
.
Janssen Pharmaceuticals and Allergan are among the pharmaceutical companies developing ketamine-like drugs for depression. Janssen is leading the effort with his esketamine nasal spray. The company filed a new drug application in September
At the same time, dozens of studies are underway to try to answer some unknowns about ketamine, including whether repeat IV treatments are more effective against depression and if it is possible to target patients.
Until there are answers, Zarate from the Mental Health Institute said that ketamine should be a treatment of last resort for depression after failure other methods. 19659002] The Associated Press Science & Science Department receives support from the Howard Hughes Medical Institute's Department of Science Education. The PA is solely responsible for all content
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