Despite its sulphurous reputation, will ketamine one day help treat depression?

Despite its sulphurous reputation, will ketamine one day help treat depression?
Despite its sulphurous reputation, will ketamine one day help treat depression?

“There is an urgent need for new treatments for severe depression and ketamine shows promise for patients who respond,” summarizes Australian researcher Julaine Allan, specializing in mental health.

Blazing action

Ketamine is not a classic antidepressant, like those developed since the 1960s. It is, basically, an anesthetic but, for around twenty years, psychiatrists have been using it as an avenue against depression.

In contrast to the usual antidepressants, ketamine acts in a dazzling manner, even if we do not know precisely by what physiological mechanisms it responds to depressive symptoms.

The editorial team advises you

It therefore appears promising in two main cases. When timely and urgent treatment is required, primarily in the face of suicidal crises but not only. And when no traditional medication works, that is to say in the case of so-called resistant depression.

There is an urgent need for new treatments for severe depression and ketamine shows promise for patients who respond.

In recent months, several studies, published in prestigious journals, have confirmed the interest of ketamine in these two perspectives.

Risk of addiction

On the front line, a study published in April in the BMJ shows that young mothers saw their risk of postpartum depression reduced after receiving a single dose of esketamine, a derivative of ketamine, at the birth of their baby. .

On the second level, a study published this Monday in Nature Medicine shows that treatment with ketamine prevented more depressive relapses compared to patients taking a placebo.

The editorial team advises you

Certainly, given the small nature of the sample – around a hundred people – and certain methodological choices, it is too early to draw a firm conclusion.

For patients for whom traditional treatments do not work, ketamine opens up the possibility of not going as far as electroshock.

But these studies contribute to a body of evidence favorable to the use of ketamine in the face of depression, a benefit which raises little doubt among psychiatrists.

“It must be considered as an intermediary between classic antidepressants and electroshock therapy,” explains psychiatrist Michel Hoffmann, based at Geneva hospitals, to AFP, who evokes real “enthusiasm” in the medical community.

The previous Matthew Perry

“For patients for whom traditional treatments do not work, ketamine opens up the possibility of not going as far as electroshocks,” he explains.

But although esketamine has already been approved for several years in the United States and Europe against certain depressions, some psychiatrists remain reluctant.

So I don’t think these tablets would attract people who want to misuse ketamine.

Without denying the effectiveness of ketamine, they fear the risk of addiction, especially since the molecule is often misused as a drug, a use sadly publicized by the overdose deaths of personalities such as American actor Matthew Perry.

“Will we soon be giving ketamine to patients with suicidal thoughts? Difficult to say, because there is a real risk that widespread use of ketamine will cause a new opioid crisis,” psychiatrist Riccardo De Giorgi warned in 2022, in an editorial in the BMJ, in reference to the health crisis that has caused hundreds of thousands of deaths in the United States due to the misuse or excessive use of certain medications.

New opioid crisis?

The challenge is therefore to reduce the risk of abuse, as well as serious side effects, such as the appearance of dissociative personality disorders.

This is the whole point of the study published by Nature Medicine. It aims to test a new method of administering ketamine: a tablet that gradually releases the treatment into the body.

The editorial team advises you

Potentially, it’s more convenient and less risky to use than intravenous treatment or a nasal spray, the two forms in which esketamine is currently approved.

In this area, the study gives promising results even if, again, they need to be confirmed.

“Patients reported few side effects: euphoria, dissociation…”, underlines its main author, Paul Glue. “So I don’t think these tablets would attract people who want to misuse ketamine. »

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