Once It Fully Catches On, Ketamine Could Be a Really Important Antidepressant

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Photo: Gary Waters/Getty Images/Ikon Images

At the moment, the study of hallucinogens as possible treatments for mental illness is in an early, exciting stage — partly because the U.S. government has, for decades, blocked off many promising avenues of exploration. It can be hard to keep up, which is why an All Things Considered segment by Jon Hamilton about the current state of ketamine research that aired yesterday is so helpful.

As Hamilton notes, psychiatrists started noticing a bit more than a decade ago that ketamine, which has been routinely used as an anesthetic in emergency-room settings for a long time, seems to offer remarkable potential as an antidepressant. “A number of small studies have found that ketamine can do something no other drug can: it often relieves even suicidal depression in a matter of hours in patients who have not responded to other treatments,” explains Hamilton. That could be because the drug targets a neurotransmitter called glutamate, while “traditional” antidepressants like Prozac act on serotonin. This different approach works wonders for some people: It’s not for nothing that the American Psychiatric Association just released a consensus statement arguing that there is “compelling evidence that the antidepressant effects of ketamine infusion are both rapid and robust, albeit transient.”

The “transient” aspect of this treatment is a challenge, Hamilton notes. The “effect tends to wear off after a few days or weeks, meaning patients need repeated infusions to keep depression at bay.” Still, given that the drug is targeting people with some of the scariest, most dangerous forms of depression, that seems to be a price patients and doctors alike are willing to pay.

It’s easy to see why when you read patient accounts, like this one from a conversation New York Magazine’s Claire Landsbaum had with “Ted,” who has received ketamine infusions for his severe depression, last year.

I am such a skeptic. I went in thinking, I’m going to watch this fail. You think you’ve seen depression? I’ll show you depression. I had completely steeled myself for disappointment. But a lot of this was motivated by desperation — I was willing to try almost anything at that point, and it sounded a lot more appealing than electroconvulsive therapy… [Afterward,] what I notice most is the silence. There’s a mental quiet — none of the continuous self-assessment, being completely certain of failure, being so certain that I’m not to going enjoy something I’ve been looking forward to for the last four months. It’s a much more peaceful place to be. It doesn’t make me feel happy; it just makes me feel not bad. It brings me back to homeostasis — to where I imagine the rest of the world lives. It gives me the ability to experience [the world] as it is rather than as a tarnished toiletbowl.

All the usual caveats apply: Anecdotes aren’t data, placebo effects are always a possibility, etcetera. But it isn’t normal for the normally staid psychiatric establishment to express this much excitement over a treatment for an often intractable and deadly condition — it’s a sign that it’s time to start bigger, more rigorous, and demanding trials. Which is exactly what it sounds like is going to happen.

Ketamine Is Looking Like a Very Important Antidepressant