Ketamine is a drug that is used to induce sedation in humans in a controlled environment. It is also used recreationally and is referred to as “Special K.” Ketamine is an NMDA antagonist that functions as a sedative, analgesic, and has therapeutic properties when used with an anesthetic. In regards to recreational usage, Ketamine has been used as a dissociative – meaning people can end up hallucinating and having out-of-body experiences. Recently, researchers have found that intranasal Ketamine spray is highly effective at treating symptoms of treatment resistant depression.

Where have we seen another NMDA receptor antagonist at play in depression? Oh yeah I wrote an article about Lanicemine for depression. Seems as though this medication was almost identical to Ketamine except the dissociative properties were stripped. The whole idea behind Lanicemine was to be used in cases of treatment resistant depression without having the major drawbacks of being labeled a dissociative substance.

Study 2014: Ketamine Nasal Spray for Major Depression

A study was recently conducted that included 20 patients that had been diagnosed with major depression. Intranasal ketamine hydrochloride was used on some of the patients, while a placebo “saline solution” (e.g. salt water) was given to other patients. This was a double blind, randomized, crossover study. Researchers measured the outcome by checking for changes in severity of depression every 24 hours using the Montgomery-Asberg Depression Rating Scale. A secondary outcome was graded based on persistence of benefit and self-report changes in depression.

Researchers also took into account the fact that Ketamine could result in dissociation or other adverse effects. All adverse effects were taken into account and measured based on symptoms and severity. As a whole patients showed major improvements in depressive symptoms within 24 hours of their first intranasal administration. A modest 8 out of 18 patients experienced an antidepressant effect from Ketamine in comparison to just 1 out of 18 following the saline “placebo.”

There were no major reports of adverse effects from the ketamine exposure. Apparently this was the first controlled study that showed how rapid the effect of ketamine can be via intranasal spray for depression. It boggles me to even think that an illicit drug wouldn’t improve depression quickly… That’s why they are illicit drugs – they make people feel good immediately, but over the long term, can lead to addiction / dependency and other psychological problems.

  • Source: http://www.biologicalpsychiatryjournal.com/article/S0006-3223(14)00227-3/abstract

Should you use Ketamine for depression? What this study means.

All that this study means is that researchers found another illicit drug that works to alleviate depression in a very small sample (just 20 people) over the short-term. I’m sure this same study could be conducted with other illicit substances and people would report improvements in mood with relatively few side effects if given at a normal dose. There’s no reason to think that this is a major breakthrough – researchers have been looking into this drug for years.

Unfortunately, this study has an extremely small sample size and cannot be generalized to the entire population. Although ketamine is effective at alleviating symptoms of major depression, so are many other things. My guess is that if you gave someone with major depression an Adderall, Ecstasy, Suboxone, Marijuana, or Psilocybin they would experience rapid depression relief as well.

If you are behind the times, AstraZeneca already developed the medication “Lanicemine” which has similar effects to Ketamine (NMDA antagonist) minus the dissociative properties. Unfortunately development for this medication stopped and no one really understands why. It seemed to be a promising new medication, but is no longer being produced… Go figure – something that works being halted after showing promise.

We also do not know whether ketamine is safe to use over the long term. What are the long term psychological effects of intranasal ketamine? There is some evidence that it may contribute to increased depression. It may also cause hallucinations if abused and/or out of body, dissociative experiences. What is going to prevent individuals from abusing this medication? In high doses it can also lead to respiratory problems.

Is dependency a concern? Absolutely. With any illicit drug, dependency is a major concern.  People that use Ketamine have been found to exhibit “cravings” for the drug.  I am all for individuals with major depression getting relief from symptoms. However, I am also for individuals with major depression getting treatment that will do more good than harm over the long term.

Since research for depression is advancing at a seemingly “snail’s pace” any breakthrough for treatment and/or management of depression symptoms, even with an illicit drug like ketamine, should be viewed as progress in the right direction.