Ketamine, a drug once associated with raucous nights, bright lights and loud music, is increasingly seen as an alternative treatment for depression for millions of patients who do not improve after trying traditional medications .
The last treatment provider is Columbia University, one of the largest academic medical centers in the country.
Since this month, Columbia has joined a growing number of large medical centers offering ketamine infusions to patients with severe depression and for whom traditional antidepressants like Prozac or Celexa have failed.
Elsewhere in the United States, patients may obtain ketamine in a few private clinics, but not all are subject to the strict medical supervision generally required by academic medical centers. In some cases, patients can also get treatment by participating in research studies, but Columbia's move makes the treatment more widely available.
Ketamine is neither cheap nor fast to administer. Because it is administered by intravenous infusion, the process can last between 45 minutes and two hours. Each session costs between $ 500 and $ 750 (Columbia costs $ 650) and is not covered by insurance because ketamine is only approved in the United States for use as an anesthetic.
Patients who take ketamine for their depression are generally advised to take 8 to 12 sessions, bringing the total cost to $ 9,000.
Despite its high price, ketamine has been described as "the most important discovery in half a century" for mental illnesses. The drug appears to involve a different part of the brain than traditional antidepressants, and its apparent quick-fire effects may be particularly useful for maintaining suicidal thoughts in people who are considering suicide, experts say. Ketamine has also been used for a long time to prevent pain, suggesting to clinicians that it is relatively safe.
"Ketamine is the real deal in that it's a true pharmacological agent used for a long time for anesthesia," Jeffrey Lieberman, director of the psychiatry department at Irving Medical Center. from Columbia University and director of the Psychiatric Institute of the State of New York, said Business Insider.
And while the applications of ketamine for mental illness are relatively new, Lieberman hopes the drug will eventually be more widely available for patients in need.
"The most important discovery in half a century"?
Most existing antidepressants, from Abilify to Zoloft, work by isolating areas where our brain absorbs serotonin, a chemical messenger that plays a key role in mood. This results in a more floating serotonin and, in some people, a relief from a black curtain of depressive symptoms. But no less than one in three patients do not respond to medication and no new medication for depression has been invented since.
These are the patients who, according to the experts, could help ketamine.
Cristina Cusin, Massachusetts General Hospital psychiatrist and assistant professor at Harvard University, told Business Insider this spring that depression can be equated with intense pain. When the pain becomes so intense that it interferes with daily activities – even something as simple as writing an email – patients may feel desperate enough to do something to alleviate the suffering. But current antidepressants take 4 to 6 weeks to work.
This is not enough for patients who need help now, said Cusin.
Read more: A handful of clinics are adopting a "festive drug" that could be a treatment for depression over fast fire – we've looked inside
A growing list of providers offering ketamine
Large institutions are starting to adopt ketamine therapy.
On the west coast, the University of California at San Diego began offering injections to select patients with severe depression in 2010. Kaiser Permanente began administering ketamine as part of a pilot program in the United States. Northern California for people who do not respond to other medications. 2015.
On the other side of the country, a handful of specialized centers have recently begun offering treatment. They include Emory, Yale and Massachusetts General Hospital, who started offering treatments this fall.
Several other medical centers, including the Cleveland Clinic, the Mayo Clinic and the Icahn School of Medicine in Mount Sinai administer the drug as part of ongoing research on ketamine and depression.
"The rapid antidepressant effects of ketamine in patients with this severe, chronic, and treatment-resistant condition can represent a true medical advance," said James Murrough, director of the Mood and Mood Disorders Program. Anxiety and associate professor of psychiatry and neuroscience. at Icahn Medical School, wrote an article in October for Scientific American.
The Columbia University program is one of the first not to require patients to show a specific number of treatments failed in the past for depression. (At Kaiser, patients must show that they have tried at least three different antidepressants and that they have not responded to any of them.)
Nevertheless, Lieberman stressed to Business Insider that experts carefully evaluate the benefits and risks before recommending treatment to a patient, and still advise people to try traditional medicines beforehand.
"We have to make a very neat story and if [someone has] a mood disorder, what is their treatment? Does the person really react to standard treatments? "Said Lieberman.
How does ketamine work?
Ketamine is thought to involve a brain system different from that targeted by traditional antidepressants. It appears to act on the key switches of the brain called NMDA receptors, which influence mood and help maintain the synapses of our brain – the delicate branches that serve as ecosystem to our thoughts – flexible and resilient.
Depression damages these brain switches. And while traditional medicines can help save them over time by using serotonin, ketamine seems to help directly at the source, clog NMDA receptors like a cork in a bottle and quickly catch depressive symptoms.
A series of recent research supports this idea of how ketamine provides relief.
Last December, researchers working with depressed and suicidal patients concluded in one study that ketamine was more effective at fighting suicidal thoughts than a commonly used sedative. Most of the study participants, published in the American Journal of Psychiatry, said their mood had begun to improve within 24 hours of taking the drug. In some people, these effects lasted more than a month.
Similarly, the authors of a review of four preliminary studies of ketamine in patients with severe depression performed in 2012 were surprised at the speed with which the drug appeared to produce positive and accurate results.
Read more: The giants of the pharmaceutical industry are looking into ketamine for clues about the next star drug of depression – and science says they already have it for a lot.
But ketamine also has several disadvantages, in addition to its high price.
Ketamine induces what many people call a high. This includes the feeling of being dissociated from one's body, floating, as well as seeing colors and vivid shapes. Some experts have suggested that this could lead to addiction problems.
In addition, the side effects of ketamine may include blurred vision, headaches and increased heart rate. And clinicians do not know how long the antidepressant effects of ketamine will last. While some patients seem to experience complete relief from their symptoms after several weeks of treatment, others do not respond or see improvement for days or even weeks.
Nevertheless, several clinics outside established medical centers also offer treatments, while some are legitimate, others are what Lieberman described as "scary" and "aggressive" in their marketing tactics.
"It's not that ketamine should not be available – it absolutely should – it simply needs to be available in a legitimate, medically controlled and rigorous environment," Lieberman said.
Ketamine inspires several attempts to create the next star drug of depression
Ketamine is also a source of inspiration for research on other new depression medications that work the same way on the brain. Approaching this chain seems to offer relief from depression, which is better, happens faster and works in more people than existing medications.
Allergan, the multinational pharmaceutical giant known for botox and birth control, recently plunged into research on an injectable drug called Rapastinel, which works on the same brain path as ketamine. The San Francisco-based VistaGen Pharmaceutical Group is working on a similar drug known only as AV-101.
Similarly, Johnson & Johnson submitted a formulation of nasal spray ketamine called esketamine to the FDA in September for review. The New York-based biotechnology company Seelos Therapeutics also has a nasal form of ketamine called SLS-002.
But the research is still early, say the experts.
"We are only touching the surface of the mechanisms of action of ketamine," Cusin said this spring.