Drug based on ketamine used to treat depression in America (May 2019)

In the Economist March 16th there appeared an article about the use of a drug based on Ketamine to treat ‘treatment-resistant’ depression, defined as not responding adequately to at least two previous antidepressants.  The Food and Drug Administration (FDA) in America has approved this drug for use under strict conditions because of its potential for abuse, together with its side effects including dissociation.  This treatment is the first genuinely new type of drug for treating depression for over 30 years. One of Ketamine’s remarkable properties is that it has a ‘broad spectrum’ effect, alleviating many of the different mood symptoms that can occur with depression, including anxiety and the inability to experience pleasure.  For patients at acute risk of suicide, for which drugs can take too long to work, there is evidence that it might be a lifesaver because it takes hold within hours and reduces suicidal thoughts. Here in the UK, Ketamine based treatment is also under consideration for use in the NHS (.https://www.nhs.uk/news/mental-health/ketamine-tested-as-severe-depression-treatment).

Ketamine for trauma treatment?

Ketamine is an anaesthetic so, according to the findings, in the previous article on the effect of anaesthetics on memory re-consolidation,  Ketamine should also affect trauma memories, and indeed it is being tested for use with these conditions.  One such case is described in some detail in Gateway’s Video 100 – Helen’s story. Helen was suffering from both drug-resistant depression and PTSD when she began treatment with Ketamine.  Subsequently, she was well enough to be treated with EMDR and has since made a full recovery. A paper on the mechanism by which Ketamine is thought to affect the memory re-consolidation process and PTSD can be found on Video 100 in the ‘Wrap up’ section.  The use of Ketamine along with EMDR psychotherapy was recommended by the Doctor who treated Helen – Dr Rupert McShane at (RNU) Oxford Health.

Growing use as a recreational drug among young people in the UK 

According to a report in the Guardian, an increasing number of young people are using Ketamine as a drug of choice.  Police seizures of the drug increased by 30% last year. According to the Government Crime Survey for England and Wales, the proportion of adults aged between 19 - 59 who had used Ketamine in the past year rose in 2017-2018 from 0.4% to 0.8% - equivalent to 141,00 more people using the drug than in the previous year.  This was driven by an increase in the proportion of 16-24year olds using the drug from 1.2% to 3.1%. Given its relative cheapness and the serious side effects this drug can induce Public Health England are naturally concerned.

Prevalence of PTSD among young people may be a significant factor.

One wonders, given the reported shortage of resources targeted at the mental health of young people, and the significant proportion of whom will have experienced trauma, whether this cohort may have ‘accidentally’ found relief through Ketamine?  According to a study published in The Lancet Psychiatry, nearly a third of 18-year-olds had experienced trauma in childhood, and a quarter of these had developed PTSD.  Researchers say that many young people do not receive the support they need and that slightly more than half of those who had had PTSD also experienced a major depressive episode and one in five had attempted suicide.  But only the same proportion – one in five had been seen by mental health professional in the past year. Without support and treatment, ‘self medication’ becomes more alluring.