It's been a tough week. We've lost two of the teenagers that survived the Parkland
school shooting. We lost the father of one of the Sandy Hook shooting victims.
Right now we have nothing to offer for patients with acute suicidal thinking.
I run a laboratory that's dedicated to understanding what goes wrong in the
brains of people with depression and what we can do to treat the symptoms of
depression. In my laboratory we use rats and mice to advance our studies.
The standard of care for treating depression right now has been the selective
serotonin reuptake inhibitors -- Prozac. These drugs act slowly, six to eight
weeks typically in patients before they begin to feel relief of their symptoms,
that's a huge problem.
The finding that ketamine produced a rapid relief of depressive symptoms
really revolutionized the field, revolutionized the way we think about
the pathology of depression and also the treatment of depression. Ketamine is a
anesthetic drug if you bring your kid to the emergency room they're very likely
to get ketamine as an anesthetic. It also produces a mildly hallucinatory
dissociative state which has led to its branding as Special K and its adoption
in the rave culture for example. The finding of the rapid antidepressant
action of ketamine in 2000 was a bit of a surprise. What hasn't gotten as much
attention is the anti suicidal action. Now we have a drug that acts within
hours to relieve their suicidal thinking in a way that will have a persistent
benefit after they leave the clinical setting, that is a fantastic ability that
we did not have before.
This is revolutionary, it's going to save thousands of lives.
Why is it taking 19 years for ketamine to finally reach patients? One of the
limitations is that the formulation that was available could only be administered
through an intravenous trip. That's a little bit of a nuisance, that's not
something that most psychiatrists would feel comfortable doing in their offices.
Another factor that limited ketamine's widespread adoption was the fear of many
people in psychiatry that these mildly hallucinatory side effects of ketamine
would in fact trigger some psychosis-like state in patients who were
repeatedly administered ketamine.
There's been a lot of excitement in the last week's because the FDA has now
approved a nasally administered form of ketamine called esketamine. The nasal
administration root has some pros and cons. The pros: It's easy to administer.
Every psychiatrists can do it in their doctor's office that's great, that will
increase availability, increase the likelihood that patients can benefit
from its rapid antidepressant actions. Of course, the negative side of making it
easily accessible and widespread is the risk for abuse. The same week that the
FDA approved the use of ketamine, with its uncertain risk for addiction,
an article was published by the American Medical Association that that really
established that although controls were put in place when fentanyl was made
readily accessible -- in the form of lollipops for example -- that those
controls failed.
Are we letting the same genie out of the bottle by creating an easily
administered form of esketamine? We don't know. Everything we know about ketamine
now has been from short administrations in defined periods of time. We really
don't know anything about chronic long-term ketamine use even in a
clinical setting. Is it safe for the brain? Is it good for mental health?
Are there people who are going to be susceptible to chronic administration of ketamine?
All the evidence that we know of now does indicate that ketamine is safe and
effective. If I had a loved one with a severe acute incidence of depression or
suicidal thinking I do think that ketamine would be the drug of choice.