(Craig Campbell)– Sometime last year I was searching for a topic for my weekly post on she-bomb.com and came across an NPR article that touted the potential benefits of ketamine as a fast-acting agent for relief from depression. It wasn’t the only one: several articles discussing the possible benefits of the drug have made rounds through popular news media in the past few years. Though the story was interesting, ultimately I decided on another topic.
Imagine my surprise, then, that when skimming articles on GoogleNews this October evening I came across several stories posted only hours before, with headlines like “The Biggest Breakthrough in 50 Years of Depression Research” and “Studies Suggest Ketamine Could Be Fast-Acting Antidepressant.”
The buzz was generated by an article published last Friday in Science, a scholarly journal for the physical sciences, by two professors of psychology at Yale. After reviewing over 50 studies that were completed in the past decade, Ronald Duman and George Aghajanian concluded that they found “ample” evidence demonstrating ketamine’s promise as an alternative antidepressant. William Weir of The Hartford Courant writes:
The most commonly prescribed antidepressants are drugs known as serotonin selective reuptake inhibitors (SSRIs), such as Paxil and Prozac. Unpleasant side effects of those drugs can kick in soon after the patient starts taking them, but the intended effect can take weeks or even months to develop. Even then, about one-third of patients are resistant to the drugs.
Ketamine, however, can reverse depression hours after administering the dose, Duman said. The effects can last up to 10 days per dose.
“The fact that ketamine can produce a very rapid and transient effect is important,” Duman said. Tests of ketamine on people who have been diagnosed as “treatment-resistant” show that 60 to 70 percent of patients respond favorably to the drug.
The established biological model of depression is rooted in the idea that a depressed person is chemically imbalanced— usually, because their brain doesn’t have enough of some neurotransmitter – and so the method of treatment involves regulating the amount of serotonin, norepinephrine, or dopamine in the brain. But these researchers use a different model to explain how ketamine provides relief from the symptoms of depression. An optimistic researcher might view ketamine as a treatment that attempts to eradicate depression closer to its source, rather than simply combating its negative effects:
Severe depression and chronic stress can shrink the prefrontal cortex and hippocampus regions of the brain, causing atrophy of neurons and damage to the synapses in those regions. Ketamine activates mTOR, an enzyme in the brain, which sets off a chain reaction that restores the synaptic connections between neurons.
Imagine this scenario: a single mother has recently given birth and is suffering from postpartum depression. Her condition cannot be cured by exercise and “happy thoughts.” She is overcome by despair, unsuccessfully attempts suicide, and lands in the psych ward of a hospital. She is unable to care for her child for the time, and her doctors put her on antidepressants. She responds favorably after a few weeks and is able to return home, with a better coping mechanism and ongoing treatment in place. Now consider the world in which ketamine is used more commonly to treat severe depression. Doctors deliver the mother a dose, she feels uplifted within 24 hours, and she is able to immediately return to care for her child.
With roughly 7% of the American adult population suffering at one time from Major Depressive Disorder, this is big news indeed, and was appropriately picked up by a variety of news media. Has the information I’ve presented sold you on the benefits of this miracle treatment for an execrable psychological disease? As always, there’s a catch, and it requires a little background on ketamine.
Developed in 1962, ketamine was initially used an anesthetic for both pediatric and veterinary surgery. A decade later, the tranquilizer made its way into both the American and British rave scene where it continues to be used today. Of its effects, Wikipedia writes that:
Ketamine produces a dissociative state, characterised by a sense of detachment from one’s physical body and the external world which is known as depersonalization and derealization… Users may experience worlds or dimensions that are ineffable, all the while being completely unaware of their individual identities or the external world. Impressions include… complete loss of bodily awareness, sensations of floating or falling, euphoria, and total loss of time perception.
So now, readers, have I altered your opinion? When I note that ketamine is an evasive target in our War on Drugs, do you suddenly have reservations about its capacity as an antidepressant?
The first paragraph of every article I looked at contained a reference to Special K, club/recreational drugs, or underground parties. Though they extolled the virtue of the potential benefits of the drug, the articles were interesting because they discuss a traditionally “bad” thing which is institutionally combatted. At the end of each story I read, I was left disappointed, wondering what was in store for the future. Why is no one asking what the next step is in studying this drug? Alas, that conversation immediately ends when we allow the language of criminal activity to enter a dialogue about treating depression. The authors of the study expressed reservations about the future of the drug, mostly because of its current Schedule III status under the Controlled Substances Act for the United States.
Read this first half of this post again and replace “ketamine” with “etomidate,” a similar short-acting intravenous anesthetic. Does that make “The Biggest Breakthrough in 50 Years of Depression Research” more legitimate? Do you take it more seriously? The issue, I think, is not with the media for focusing on the drug’s illicit status, nor with the government for scheduling it; the problem is with us, and our difficulty in letting go hard-wired associations (ketamine = drug = scary) in order to better understand the problem, as well as its potential “miracle” solution.