Study: ketamine infusions alleviate sadness, anxiety, and suicide ideation. Patients with depression, anxiety, and suicide ideation who received intravenous ketamine at one of three private ketamine infusion clinics showed “substantial improvement,” according to a recent study.
The new study adds to the expanding body of evidence supporting ketamine’s efficacy in treating these problems; it was published on Monday in the Journal of Clinical Psychiatry.
According to Dr. Gerard Sanacora, a professor of psychiatry at Yale University School of Medicine, “it delivers some additional real-world evidence, which is tremendously important” since it helps prove its ability to function in a broader general population.
However, he cautioned that it was impossible to draw any firm conclusions about how the study’s findings should be applied because of important information missing from it, such as statistics on side effects and direct comparisons to alternative options.
Anesthesia is the primary clinical application for the potent drug ketamine. The powerful high and dissociation effects it produces also make it a popular illegal club drug. Since it is not FDA-approved for the treatment of depression and is therefore used “off-label,” insurance companies will not pay for it even if a doctor prescribes it.
Between November 2017 and May 2021, researchers examined data from 424 patients with treatment-resistant depression who had infusions of ketamine at one of three Virginia clinics specializing in the treatment of suicidal ideation, depression, or anxiety. Patients filled out mental and physical health questionnaires at each clinic appointment. Six infusions were administered to the patients over the course of 21 days.
Researchers found that 50% of subjects reacted to infusions within six weeks, with 20% reporting complete remission of depressive symptoms. The response and remission rates were 72% and 38% after 10 treatments, respectively.
The study found that 50% of patients who had suicidal thoughts experienced remission after 6 weeks and that 30% of patients experienced a reduction in anxiety symptoms throughout treatment.
Initial response rates were comparable to those of oral medicine and transcranial magnetic stimulation for treatment-resistant depression, according to the study authors. Remission rates were similar to transcranial stimulation but lower than those seen in ECT clinical trials that had been optimized for efficacy and safety.
The lack of a blinded trial with a control group is one of the research’s drawbacks. It relied on self-reported questionnaires and didn’t consider patients who chose not to receive infusions.
The study authors admit that they didn’t thoroughly evaluate any potential negative consequences of the medication, but they also highlight that previous research has found no permanent negative effects on memory or cognitive decline.
Sanacora called it “disappointing” that there was so little known about potential side effects. The “unique collection of risks, both to the individual and to society” associated with ketamine usage include the potential for drug misuse and the unknown repercussions of regular, especially heavy, use.
However, it is difficult to assess the advantages against the risks without the adverse effects data and without comparing outcomes to a control group or otherwise.
He argued that while this medication holds great promise for alleviating the suffering caused by severe mood disorders and psychiatric conditions, it must be used with caution and responsibility.
A nasal spray containing esketamine, a close relative of ketamine, was approved by the US Food and Drug Administration in 2019 for the treatment of depression that had not responded to other therapies. Racemic ketamine (which uses two types of ketamine molecules, in contrast to esketamine’s single form) infusions are less expensive than esketamine, according to the current study’s authors, and may save money if they were reimbursed by insurance.
