September 2014

Ketamine Holds Promise to Revolutionize the Treatment of Depression

Major depression disorders affect a significant portion of the world population at any moment and account for a major loss of quality of life. For those living with this disease and their families, treatment options can feel limited. A common frustration expressed by the consumers of anti-depression medication is the length of time between prescription and the relief of symptoms. Regularly prescribed SSRIs, such as Prozac and Zoloft, can take weeks or even months to kick in. Even then about 20 percent of patients are treatment-resistant (don't see any effect from these drugs.)

But a new treatment that is very fast acting (relief of symptoms in hours) in treating resistant depression has been discovered almost by accident. It was observed that by administering ketamine, an anesthetic commonly used in surgery, symptoms of depression were rapidly relieved, even in patients with treatment-resistant depression. After the initial reports of the antidepressant effects of ketamine, multiple research studies were conducted across the country. Impressive results were obtained; a substantial response being observed in 50-80% of patients compared to an initial response rate of 30% with any one of the currently accepted antidepressants. Even more importantly, suicidal ideation, which is a major cause of hospital stays and suicide, was rapidly resolved in the majority of cases.

Bruce Morris was a participant in one such study at Columbia University that included a daily intravenous dose of ketamine and a MRI scan to allow investigators to follow the impact on his brain. (While researchers continue to investigate exactly how ketamine works, they hypothesize the drug repairs brain cells that have been damaged because of depression by increasing glutamate and aminobutyric acid levels in the front of the brain.) “I suddenly realized that I was enjoying the sun shining outside my window,” says the 31-year-old who’s been living with major depressive disorder (MDD) since adolescence. “My mind wasn’t so crowded with negative thoughts and I was able to simply enjoy the nice day.”

In a review of this study and others like it, Yale professors George Aghajanian and Ronald Duman say the emerging ketamine treatment is "arguably the most important discovery"—when it comes to depression—"in half a century."

As it stands now, the practice of using ketamine as an antidepressant is not feasible because of the high cost and impracticality of administrating intravenous infusions every few weeks. But researchers expect effective treatments will be made available as research progresses. Trials are already waiting approval to study other ways to take ketamine: in pill and nasal spray form.

Remote Roundup

What Matters Most? Information Priorities for Treatment of Depression
Depression is the most common mental health disorder among Americans, and recognition and treatment are increasing. This survey seeks to identify patient information priorities in the treatment of depression. Dartmouth College is inviting adults who have been treated for depression, live in the U.S. and are comfortable reading and writing in English to participate. You will complete an online survey that should take about 10 minutes. The information will be collected and maintained anonymously. No names or other identifying information will be collected.

The interactions of persons with a mental illness and their relatives
the University of Pennsylvania is conducting an online survey that takes approximately 15 minutes to complete. They aim to recruit adults who have a family member (including romantic partners) who have been diagnosed with a mental health condition. The study seeks to gain knowledge about the types of interactions people are having with family members who have a mental illness, including caretaking, limit-setting, and possible conflict.

Healthy Mood Study
This is an online study being conducted by Palo Alto University’s Institute for International Internet Interventions for Health (i4Health). The study compares several very brief methods to help people improve their mood. Most people take between 10 and 20 minutes to complete it. If you choose to participate, you will answer a few questions about your mood and be assigned by chance to one of 5 very brief techniques. If you provide us your e-mail, in 1 week we will send you an email with a link to a brief (5 minute) follow-up questionnaire to find out your mood during the week. Your email will not be shared with anyone outside the research team.