Ketamine, a powerful anesthetic, holds promise for treating depression and other psychological maladies. Ketamine is also used as an illicit drug in the rave scene, known for producing euphoric, out of body experiences. Called “Special K,” it’s among the most commonly abused drugs. But it looks like it has a legitimate use as a depression-fighting medication. Ketamine works by blocking the action of the NMDA receptors, affecting the availability of the neurotransmitter glutamate. Glutamate is the most prevalent neurotransmitter in the human nervous system. Its actions affect 90% of all the connections in the brain.
SSRIs, the class of drug that includes Paxil, Prozac, Lexapro, Zoloft, and Celexa. The work well for about one-third of depression sufferers, moderately well for another third, and not at all for the final third of those diagnosed with depression. However, even when an SSRI works, it takes weeks for them to take effect. Two weeks at least, but four to six weeks is usually the time span needed for maximum benefit. That’s far, far too long for people with overwhelming suicidal thinking. For those at imminent risk of suicide, sometimes hospitalization in a behavioral health facility with round the clock supervision is the only way to stay alive. Costs for this kind of care can easily run around 1000 dollars a day, with insurance typically covering around 50% to 80% of the costs–but only up to the limit of the patient’s policy. It’s entirely possible for patients to leave a behavioral health hospital owing tens of thousands of dollars for stays over a couple of weeks. Even after such a lengthy hospitalization, there’s no guarantee that the anti-depressants won’t suddenly and catastrophically stop working.
Johnson & Johnson is currently testing esketamine, a drug that’s highly similar to ketamine. Esketamine is in Phase III research trials, which will lead to approval or denial by the FDA. If approved, esketamine will be used to treat treatment-resistant depression. About one-third of depression suffers have hard to treat depression, depression that doesn’t respond well to medication. Allergan Pharmaceuticals is testing rapastinel, a related derivative of ketamine. Unlike SSRIs and other classes of antidepressants, ketamine starts working within hours or less. The effects of a single treatment can last up to a week, and daily dosing with lozenges and nasal spray is also in the works. Due to its swift action, ketamine would be a godsend for people at imminent risk of self-harm or suicide. It works rapidly and relieves depression so well that ideas of suicide subside and vanish for up to a week. Daily dosing ensures that the treated individual stays free of suicidal thinking.
Ketamine isn’t a miracle drug, and it’s no cure for depression. It will not eliminate suicide universally. However, it looks like it will be a lifesaver for thousands of people who every year find themselves in the deepest, darkest pits of depression. For those for whom suicide seems like a reasonable choice, prescription ketamine and its derivatives could be the difference between life and death.