People who received ketamine intravenously at three private ketamine infusion clinics experienced “significant improvement” in symptoms of depression, anxiety and suicidal ideation, according to a new study published Monday. (CNN)
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WASHINGTON — People who received ketamine intravenously at three private ketamine infusion clinics experienced “significant improvement” in symptoms of depression, anxiety and suicidal ideation, according to a new study.
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.
This “gives 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, professor of psychiatry at Yale School of Medicine.
But the study leaves critical gaps, including data on adverse effects and direct comparisons with other options, that make it difficult to conclude how it should be used, he said.
Ketamine is a powerful drug used in hospitals primarily as an anesthetic. It is also used illegally as a club drug which creates an intense high and dissociative effects. Because it is not approved to treat depression and is therefore used for this “off-label” purpose, it is not covered by insurance, even if recommended by a doctor.
Researchers looked at data from 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. . At each clinic visit, patients completed physical and mental health questionnaires. Patients received six infusions over 21 days.
Within six weeks of starting the infusions, the researchers said, half of the participants responded to treatment and 20% had depressive symptoms in remission. After 10 infusions, the response and remission rates were 72% and 38%, respectively.
Half of the patients who had suicidal thoughts were in remission after six weeks, and there was a 30% reduction in anxiety symptoms during treatment, according to the study.
According to the researchers, response rates in the initial phase of treatment were similar to oral medications and transcranial magnetic stimulation for treatment-resistant depression. Remission rates were comparable to transcranial stimulation, but were not as helpful as optimized trials of electroconvulsive therapy, both of which can be more expensive and carry additional risk.
Limitations of the research include that it was not a blinded study with a control group. It did not examine people who refused to receive infusions and relied on self-reported surveys.
The researchers also note that they have not systematically assessed side effects or adverse events of treatment, but previous studies have found no long-term or permanent side effects on memory or cognitive decline.
I think it’s an extremely important treatment to add to our arsenal for combating serious mood disorders and psychiatric illnesses, but we must use it responsibly and carefully.
–Dr. Gerard Sanacora, Yale School of Medicine
The lack of information about adverse effects is “disappointing,” Sanacora said. Ketamine comes with a “unique set of risks, both for the individual and for society”, including the potential for drug abuse and the unknown effects of frequent use, especially at higher levels.
But without data on adverse effects — and without comparing results to a control group or otherwise — it’s hard to know how to weigh the benefits against the risks.
“My point is that I think it’s an incredibly important treatment to add to our arsenal for dealing with serious mood disorders and psychiatric illnesses, but we need to use it responsibly and carefully,” a- he declared.
In 2019, the United States Food and Drug Administration approved a nasal spray that uses esketamine, a cousin of ketamine, for treatment-resistant depression. The researchers of the new study say that infusions of racemic ketamine (which uses two forms of ketamine molecules, unlike the single form of esketamine) are cheaper than esketamine and could result in savings if covered by a insurance.
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