| Prescription K

There is a substantial, well -debated, and disputed list of recreational drugs which have been used to treat psychosocial illnesses in decades past, and now that list has a new addition.  Ketamine, a horse tranquilizer often used as a party drug, has now found its own nook following the publication of a paper early this month in Science, a world-renowned medical journal.

Following over a decade of research by Ronald Duman and George Aghajanian, both psychiatry professors at the Yale School of Medicine, scientists have found that low doses of the compound may reverse signs of depression in patients in over just a few hours.

Ketamine – also known as K, Special K, and Vitamin K – has been classified as a Schedule I narcotic in Canada since 2005, but Schedule III in the United States since 1999. Despite this, it is FDA-approved for use as an injected anesthetic.

Ingested and injected, effects last an hour or two, producing varied levels of dissociation in the user. It manifests in varied levels of pleasant dream-like states, vivid imagery, hallucinations, and emergence delirium.

Besides these hallucinatory side effects, the drug’s real medicinal potential is only fully realized by looking deeper and in evaluating its specific effects on synapses. The paper states that ketamine is able to stimulate synaptic growth and promote their regeneration, to counter the loss of the same – which is symptomatic of depression.

“Depression is a neurodegenerative disease, and people long thought that it was very hard to reverse such a thing,” Aghajanian told the Yale Daily News. “That’s the amazing thing about Ketamine – it reverses the changes within 24 hours.”

“The idea that a drug could produce a rapid improvement, rather than taking several months to feel better is really an important idea and it really challenges the thinking about how anti-depressant medications might work,” Yale Chair of Psychiatry John Krystal told the Yale Daily News. “I think [it provides] a lot of hope for the future for the treatment of depression.”

Comparatively, the SSRIs [Selective Serotonin Reuptake Inhibitors] that have been used to treat depression only begin to take effect over seven weeks of daily use, on average.

In treating depression, issues of timing can be crucial; the risk of potential self harm and suicide over the weeks it takes for SSRIs to kick in fosters a stressful environment for not only the person who must continue to operate within the routines and responsibilities of their daily lives, but also stresses their familial and social spheres.

In the United States alone, 14.8 million people are afflicted with major depressive disorders yearly, according to the National Institute of Mental Health (NIMH) – that’s 6.7 per cent of the population.

Clearly, then, the promise of a (relatively) instantaneous cure brings interest.

While Ketamine therapy offers a tempting picture of a medical revolution, any dialogue following the publication of scientific studies like this necessitates a consideration of the flipside, one that seems vast and troublesome now.

For one, Ketamine has  been associated with psychosis in high doses and prolonged use. With the drug’s widespread presence within the recreational sphere, a question must be asked regarding its off-prescription use. Were Ketamine to gain acceptance as a prescribed medication, would there be an increase in recreational use that would create a larger black market?

Without insinuating that there is a current lack of supply, one can assume that supply would be greatly increased should Ketamine be prescribed. For patients, a black market could be tempting.

While Ketamine prescriptions have not emerged into mainstream medicine just yet, there have been reports of “off label” uses of the drug to treat depression given its FDA approval as an injected anesthetic.

The Yale findings come with another disclaimer that hints at some side potential failings of the drug. Their research shows that patients, taken off the medication, relapse between one and two weeks with all their corresponding improvement reversed.

Would this reversion be avoided with continued use? Perhaps more importantly, if patients relapsed, would they find their depression worse than it was before treatment?

Alongside these queries, there enters yet another factor, that of the addictive potential of Ketamine, as well as its reality-altering side-effects, which include the aforementioned dream-like states, hallucinations, immediate delirium, and irrational behavior. It seems idealistic to assume that advantages could outweigh the destructive potential of the drug.

While this research clearly takes treatments for depression into a markedly different territory, there are many questions and considerations that remain unanswered. There is a need for further research before Ketamine is simplistically promoted as the new miracle cure for depression.

It will be essential to formulate a compound able to impact synapses without the detrimental side effects of Ketamine itself, a safer alternative that researchers are now working on. Rather than being seen as in support for swapping SSRIs with Ketamine, the paper should perhaps be taken as revolutionary for exposing the regenerative capabilities of a compound, and consequently providing a basis for formulating depression remedies that have side effects with less damage potential.

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