Can Ketamine Treat Depression?
Dennis S. Charney, MD, is the Dean of the Mt. Sinai School of Medicine and a world expert in the neurobiology and treatment of mood and anxiety disorders. He has made fundamental contributions to the understanding of neural circuits and neurochemistry related to human anxiety, fear, mood and discovery of new treatment for mood and anxiety disorders. He later expanded this area into pioneering research related to the psychobiological mechanisms of human resilience to stress. He's a professor of neuroscience at Mt. Sinai.
A prolific author, Dr. Charney has written more than 700 publications, including groundbreaking scientific papers, chapters, and books. He has authored a many books, including Neurobiology of Mental Illness (Oxford University Press, USA, Third Edition, 2009); The Peace of Mind Prescription: An Authoritative Guide to Finding the Most Effective Treatment for Anxiety and Depression (Houghton Mifflin Harcourt, 2004); The Physicians Guide to Depression and Bipolar Disorders (McGraw-Hill Professional, 2006), and Resilience and Mental Health: Challenges Across the Lifespan (Cambridge University Press, 2011). Dr. Charney’s most recent book is Resilience: The Science of Mastering Life’s Greatest Challenges (Cambridge University Press).
Dennis Charney: Depression is a very serious clinical problem. Work has been going on for many years to discover better treatments for depression. Most depression treatments, medicine I’m talking about, take weeks to months to work like Prozac and Paxil and so that’s been a problem in that there’s a delay and they also don’t work in everybody. So my research team has been working for many years to discover better treatments, better medicine treatments for depression. And we have recently found that ketamine is a rapidly acting antidepressant. Now some people know ketamine as a recreational drug of abuse called Special K, but we have found that it has potential for the treatment of depression that had not responded to traditional antidepressant treatments and that it works faster – that it can work within several hours.
So we’re working on it. It’s not yet approved so it’s now at the level of research but it’s now been found that by research groups all over the world that ketamine works quickly and that the response can at least be maintained for several weeks. So now we’re working on how to maintain the response for much longer than that and to test out its safety for long term treatment but at a minimum its broken new ground because ketamine works differently than other antidepressants and we now know that there are methods that get people better from serious forms of depression very quickly.
One reason that scientists say that the ketamine findings are a major advance in the treatment of depression is that ketamine works very differently than other antidepressants. The antidepressants that are now generally available work through monoamines, neurotransmitters like serotonin, and norepinephrine. That’s how Prozac and Paxil and Zoloft, for example, work. They block the reuptake of the neurotransmitter serotonin. Ketamine does not work through that mechanism. Ketamine works through another neurotransmitter system called the glutamate system. And initially it’s effects are modulated by blocking the NMDA glutamate receptor. So we know that’s part of the way that ketamine works. But researchers now in labs around the world are probing more deeply about how ketamine can start by working through the glutamate system and then cause other changes in brain function that result in that antidepressant response. So that is work that is now occurring. But we do know it at a minimum that it works very differently than the available antidepressants.
As I mentioned ketamine is a recreational drug of abuse and we have to be concerned about that in any development of ketamine, at least a formal approval by the FDA and ultimately it becomes generally available for the treatment of depression. So the clinical studies that are now being undertaken by a major pharmaceutical company is studying intranasal forms of ketamine and they will watch for any signs of abuse by patients. Probably the way ketamine will be distributed will be on a dose by dose basis and that for patients that have a history of substance abuse it may not be the appropriate drug, you know, to use. But I personally feel that ketamine is well tolerated in the dose that we use for the treatment of depression and that if longer term studies show that it’s safe and that it’s not abused it could really revolutionize the treatment of depression for patients who have serious depression that is treatment resistant to the available treatments. So it’ll be used for a very certain group of people who are really suffering.
Directed/Produced by Jonathan Fowler, Elizabeth Rodd, and Dillon Fitton
Dr. Dennis Charney discusses recent research that shows that ketamine may be an effective treatment for depression in people who have been resistant to other treatments.
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