Special K: Ketamine, From Party Drug To Depression Medication

When you picture the drug ketamine, you might think of that stoner you knew in high school or a bunch of people popping pills in neon-lit clubs.

But do you ever picture a dentist's office? Ketamine is often used as an anesthetic for procedures on people’s teeth.

And it’s a multi-tasker. The Food and Drug Administration recently approved Spravato, a drug based on ketamine, called esketamine, to treat depression via a nasal spray.

Here’s more about the FDA’s designation from The Verge:

The drug must be administered as a nasal spray, patients must be taking another antidepressant at the same time, and it can only be given to patients who have (unsuccessfully) tried two antidepressants before. Most notably, people won't able to pick up Spravato at the local Rite Aid. Spravato will only be available in certified clinics.

Ketamine may not work for every patient, but for some, it may come as an enormous relief.

About 12 to 20 percent of adults with depression don't respond to other types of treatment or medication. That population is called “treatment resistant.”

And some of the more commonly prescribed drugs, like Prozac or Trazodone, don't have the efficacy we might hope for; studies show only around 37 percent of those who use these medications experience full remission.

Journalist Alice Levitt is one of those treatment-resistant patients. And she finally tried ketamine. Here’s part of what she wrote for Vox about her experience:

Each infusion lasted 45 minutes. After my first one, I had a nurse play the cast album of my favorite musical as the drip began. Instead of running wild, my mind became immersed in the music, albeit in a deeply dreamlike state. Each time, it took about 15 to 20 minutes after the effects of the treatment wore off for me to be able to open my eyes and start walking. Afterward, I was exhausted. The half-hour Uber ride home felt like hours as I longed for the warm embrace of a nap.

Immediately after each treatment, I felt down. But by the time I woke up the next day, I was in less psychic pain and had more purpose. I would start the day on my long-neglected spin bike, feeling motivation that I'd lacked for months. Lunches with friends no longer felt like they existed just to show them I was still alive and making an effort to get out of the house. I was beginning to connect with the world outside my head again. I noticed myself smiling more. According to Shah, feeling the effects of ketamine within 24 hours of treatment is typical. “It is the most rapid-acting treatment for depression,” he said.

After the final infusion, I had the initiative to start writing again. The following week quickly filled up with activities, both work and fun. I was living for the first time in months. It's been three months since my last treatment, and I've even started to feel excited about my future. Shah says I am unlikely to need another dose — I was in the roughly 70 percent who achieve remission after one series of ketamine infusions.

And while the research still doesn't conclusively show that esketamine or ketamine causes depression to go away, the FDA said it approved Spravado because patients needed a new alternative.

How do we treat an illness that affects millions of Americans? And why does it seem to be so challenging to find things that help?

Produced by Gabrielle Healy. Text by Gabrielle Healy.

If you or someone you know needs to talk to someone, the National Suicide Prevention Hotline is 1-800-273-8255, and the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Referral Helpline is 1-800-662-HELP (4357)

GUESTS

Dr. Gary Sachs, Associate clinical professor in psychiatry at Harvard Medical School

Dr. Demitri Papolos, Co-director of the Program in Behavioral Genetics and associate professor of clinical psychiatry at the Albert Einstein College of Medicine at the Montefiore Medical Center

Alice Levitt, Writer covering medicine, travel and food, @aliceeats

For more, visit https://the1a.org.

© 2019 WAMU 88.5 – American University Radio.

Copyright 2019 WAMU 88.5. To see more, visit WAMU 88.5.