“Special K” for Depression

The past few weeks the news has been inundated with celebrity suicides. First Avicii, then Kate Spade, and now Anthony Bourdain. New data published by the Centers for Disease Control reveal that suicide rates are increasing and are up 30% since 1999. Clearly, something needs to be done.

While traditional psychiatric medications can help alleviate depressive symptoms, these medications can take weeks to months to have their full effect, and do not work for everyone. Depressed patients are left struggling while they wait for the medication to kick in. We need something that can rapidly reverse suicidality and bring comfort to suffering people.

Interestingly, a club drug, in the same class as phencyclidine (PCP) and dextromethorphan (DXM), may be the answer. Ketamine (also known as “K2”, “Special K”, or more interestingly “psychedelic heroin”) has been used for over 50 years in the medical field. When PCP was first being tested as an anesthetic in humans, it was noted to cause an intense and prolonged delirious state (unsurprisingly). Ketamine, with its reduced potency and shorter half-life, was just the solution. It continues to be used as an anesthetic for children and as a rapid induction agent for anesthesia in emergency departments.

Once it came on the market in the 1970s, ketamine began to be diverted for its dissociative properties. Noted to cause feelings of being detached from reality with changes in sensory perceptions and the sense of floating, ketamine became used on the club scene. One Reddit user describes ketamine as “there’s uppers and there’s downers; get ready to be sideways for once.”

Newer research has delved into ketamine’s application as a rapid reliever of suicidality and as a fast-acting antidepressant. Studies have demonstrated that a single IV or intranasal dose of ketamine (at doses lower than those that would cause anesthesia) can produce antidepressant effects in patients with treatment-resistance depression. Furthermore, and perhaps more importantly, ketamine has also been shown to cause rapid resolution of suicidal ideation 1.

The antidepressant effects of intranasal esketamine (the S-entantiomer of ketamine) occur within hours. While perceptual changes occur for only 2 hours after dosing, antidepressant effects may persist for at least 8 weeks after a period of treatment 2. Furthermore, the intranasal formulation was remarkably well tolerated – the most common side effects were dizziness, nausea, and dissociative symptoms 2.

Ketamine has excited the psychiatric world. Patients may no longer need to wait weeks for an antidepressant to work and may be able to alleviate some of their depressive symptoms within hours of seeking treatment. For those suffering from suicidal ideation, this drug may be life-saving.

While longer term data is needed on the neurological effects with continued use, esketamine (the intranasal formulation) may be available in the U.S. as early as 2019. Ketamine IV infusion clinics have already starting appearing across the world, though insurance does not frequently cover this treatment.

Perhaps in the future, when a depressed patient presents to the emergency room with suicidal ideation, they’ll be given an IV infusion or intranasal dose of ketamine before being sent to the psychiatric ward. Their recovery will be hastened and their suffering eased.

Sources

  1. https://www.ncbi.nlm.nih.gov/pubmed/28969441
  2. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2666767