Ketamine infusions improve symptoms of depression, anxiety and suicidal ideation, study says

AND INTRODUCES US TO A MAN WHO SAYS IT’S CHANGED HIS LIFE. REPORTER: CALEB SNOVEL KNOWS DEPRESSION ISN’T EASY TO TALK ABOUT. >> I WOULD FIND MYSELF SITTING IN THE CAR JUST WITH PARALYSIS , JUST NOT ABLE TO GET OUT AND GET MOTIVATED BY ANY MEANS. REPORTER: BUT HE DECIDED TO GIVE ONE TREATMENT A TRY. A KETAMINE IV THERAPY. THE DRUG HIT THE MARKET IN THE 1970’S AS AN ANESTHETIC MEDICATION FOR SURGERY. THEN BECAME A POPULAR PARTY DRUG, KNOWN ON THE STREETS AS SPECIAL K. BUT IN THE LAST DECADE, ITS BEEN DEVELOPED AS TREATMENT FOR THOSE FIGHTING DEPRESSION. >> IF IT’S AT WORK, IF IT’S DOING CHORES AT HOME, IF IT’S GOING TO SCHOOL, IT REALLY SORT OF TAKES PEOPLE’S LIVES AWAY. REPORTER: UAB’S DR. RICHARD SHELTON IS INVOLVED WITH A NEW TREATMENT JUST APPROVED BY THE FDA IN MARCH. > IT’S A LOW-DOSE INTRANASAL SPRAY FOR PATIENTS WITH TREATMENT-RESISTANT DEPRESSION, OR DEPRESSION THAT DOESN’T RESPOND TO EXISTING THERAPIES. DR. SHELTON SAYS THE SPRAY USES ESKETAMINE, WHICH IS THE ACTIVE FORM OF KETAMINE, REDUCING SOME OF THE SIDE-EFFECTS ASSOCIATED WITH THE DRUG. >> WE CAN SEE DEPRESSION IMPROVE WITHIN 24 HOURS WITH SOME FOLKS, WHEREAS A STANDARD ANTI-DEPRESSANT CAN TAKE WEEKS OR EVEN MONTHS TO WORK. REPORTER: UAB SAYS THIS IS THE FIRST COMPLETELY NEW DEPRESSION MEDICINE IN YEARS, WITH UAB DIRECTLY INVOLVED IN CLINICAL TRIALS. SHELTON DOES WARN PEOPLE CAN STILL SEE SIDE-EFFECTS, LIKE DISSOCIATION AND NAUSEA. >> IT HAS GIVEN ME THE ABILITY TO FIND THAT MOTIVATION AND DRIVE AGAIN TO PURSUE MY PASSION. REPORTER: THROUGH HIS KETAMINE TREATMENTS, SNOVEL SAYS HIS LIFE HAS CHANGED DRAMATICALLY. SHOWING OTHERS YOU DON’T HAVE TO SILENTLY STRUGGLE. >> IF YOU’RE FEELING THIS WAY, DOWN, DEPRESSED, DISCOURAGE, UNMOTIVATED, I WOULD HIGHLY ENCOURAGE ANYBODY OUT THERE TO GIVE KETAMINE A TRY. REPORTER: BECAUSE HELP MAY CAN COME IN MANY FORMS. IN BIRMINGHAM, MARY O’CONNELL, WVTM

People who got intravenous ketamine at three private ketamine infusion clinics had "significant improvement" in symptoms of depression, anxiety and suicidal ideation, a new study says.The study, published Monday in the Journal of Clinical Psychiatry, adds to a growing body of research showing ketamine's promise in treating these conditions.It "gives some more real-world data, which is incredibly important" because it helps show its potential to work in a more general population, said Dr. Gerard Sanacora, a psychiatry professor at the Yale School of Medicine.But the study leaves some critical gaps, including data on adverse effects and direct comparisons to other options, that make it difficult to conclude how it should be used, he said.Ketamine is a powerful medication used in hospitals primarily as an anesthetic. It's also used illegally as a club drug that creates intense high and dissociative effects. Because it's not approved to treat depression and thus is used for that purpose "off-label," it is not covered by insurance, even when it's recommended by a doctor.The researchers looked at data on 424 people with treatment-resistant depression who were treated between November 2017 and May 2021 at three ketamine infusion clinics in Virginia that specialize in people with suicidal ideation, depression or anxiety. During each visit to the clinic, the patients filled out physical and mental health surveys. The patients were given six infusions within 21 days.Within six weeks of beginning infusions, the researchers say, half of the participants responded to the treatment, and 20% had depressive symptoms in remission. After 10 infusions, response and remission rates were 72% and 38%, respectively.Half of the patients who had suicidal ideation were in remission after six weeks, and there was a 30% reduction in anxiety symptoms over the course of treatment, according to the study.Response rates in the initial phase of treatment were similar to those of oral medication and transcranial magnetic stimulation for treatment-resistant depression, the researchers say. Remission rates were on par with transcranial stimulation but weren't quite as helpful as optimized trials of electroconvulsive therapy, both of which can be more expensive and carry added risk.Limitations of the research include that it was not a blind study with a control group. It didn't look at people who declined to have infusions, and it relied on self-reported surveys.The researchers also note that they didn't systematically assess side effects or adverse events of the treatment, but previous studies have not found long-term or permanent side effects on memory or cognitive decline.The lack of information about adverse effects is "disappointing," Sanacora said. Ketamine comes with a "unique set of risks, both to the individual but also to society" including the potential for drug abuse and unknown effects of frequent use, especially at higher levels.But without the adverse effects data — and without comparing outcomes to a control group or otherwise, it's hard to know how to weigh the benefits against the risks."My point is, I think this is an incredibly important treatment to add to our armamentarium to fight severe mood disorders and psychiatric illnesses, but we have to use it responsibly and carefully," he said.In 2019, the U.S. Food and Drug Administration approved a nasal spray that uses esketamine, a cousin of ketamine, for treatment-resistant depression. The researchers on the new study say that infusions of racemic ketamine (which uses two forms of ketamine molecules, in contrast with esketamine's single form) are cheaper than esketamine and could result in savings if they were covered by insurance.

People who got intravenous ketamine at three private ketamine infusion clinics had "significant improvement" in symptoms of depression, anxiety and suicidal ideation, a new study says.

The study, published Monday in the , adds to a growing body of research showing ketamine's promise in treating these conditions.

It "gives some more real-world data, which is incredibly important" because it helps show its potential to work in a more general population, said Dr. Gerard Sanacora, a psychiatry professor at the Yale School of Medicine.

But the study leaves some critical gaps, including data on adverse effects and direct comparisons to other options, that make it difficult to conclude how it should be used, he said.

Ketamine is a powerful medication used in hospitals primarily as an anesthetic. It's also used illegally as a club drug that creates intense high and dissociative effects. Because it's not approved to treat depression and thus is used for that purpose "off-label," it is not covered by insurance, even when it's recommended by a doctor.

The researchers looked at data on 424 people with treatment-resistant depression who were treated between November 2017 and May 2021 at three ketamine infusion clinics in Virginia that specialize in people with suicidal ideation, depression or anxiety. During each visit to the clinic, the patients filled out physical and mental health surveys. The patients were given six infusions within 21 days.

Within six weeks of beginning infusions, the researchers say, half of the participants responded to the treatment, and 20% had depressive symptoms in remission. After 10 infusions, response and remission rates were 72% and 38%, respectively.

Half of the patients who had suicidal ideation were in remission after six weeks, and there was a 30% reduction in anxiety symptoms over the course of treatment, according to the study.

Response rates in the initial phase of treatment were similar to those of oral medication and transcranial magnetic stimulation for treatment-resistant depression, the researchers say. Remission rates were on par with transcranial stimulation but weren't quite as helpful as optimized trials of electroconvulsive therapy, both of which can be more expensive and carry added risk.

Limitations of the research include that it was not a blind study with a control group. It didn't look at people who declined to have infusions, and it relied on self-reported surveys.

The researchers also note that they didn't systematically assess side effects or adverse events of the treatment, but previous studies have not found long-term or permanent side effects on memory or cognitive decline.

The lack of information about adverse effects is "disappointing," Sanacora said. Ketamine comes with a "unique set of risks, both to the individual but also to society" including the potential for drug abuse and unknown effects of frequent use, especially at higher levels.

But without the adverse effects data — and without comparing outcomes to a control group or otherwise, it's hard to know how to weigh the benefits against the risks.

"My point is, I think this is an incredibly important treatment to add to our armamentarium to fight severe mood disorders and psychiatric illnesses, but we have to use it responsibly and carefully," he said.

In 2019, the U.S. Food and Drug Administration approved a nasal spray that uses esketamine, a cousin of ketamine, for treatment-resistant depression. The researchers on the new study say that infusions of racemic ketamine (which uses two forms of ketamine molecules, in contrast with esketamine's single form) are cheaper than esketamine and could result in savings if they were covered by insurance.

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